Near-drowning in the Dead Sea: a retrospective observational analysis of 69 patients

Abstract

Background: The Dead Sea in Israel has a very high mineral content. Near-drowning in the Dead Sea is expected to result in severe electrolyte abnormalities and respiratory failure. Previous limited studies reported a high mortality rate.

Objective: To evaluate the clinical and biochemical manifestations and disease outcome of near-drowning in the Dead Sea.

Methods: Data were abstracted from the archives of Soroka University Medical Center. The cohort comprised 69 patients who nearly drowned in the Dead Sea.

Results: The median age of the patients was 68 years (range 21-84). There were two major manifestations of near-drowning in the Dead Sea: electrolyte imbalance and acute lung injury. Serum calcium, magnesium and phosphorus (but not sodium, potassium and chloride) were abnormal in most patients. Median serum electrolyte levels (and range) on admission were 10.9 mg/dl (9-24) for calcium, 4.3 mg/dl (1-30) for magnesium, and 4.1 mg/dl (2-9) for phosphorus. These levels quickly normalized with forced diuresis within 24 hours. Acute lung injury--namely, hypoxic bilateral pneumonitis--occurred in 29 patients. Mechanical ventilation was required in 11 patients. Sixty-five patients recovered fully, while the remaining 4 had minor sequelae.

Conclusions: Near-drowning in the Dead Sea is a syndrome of severe electrolyte abnormalities and lung injury. Early treatment with forced diuresis and supportive care results in prompt recovery.