How are volume depletion and acidosis due to drowning treated?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Significant disorders of vascular volume are not common after drowning, although intravascular volume depletion has been attributed secondary to pulmonary edema and intracompartmental fluid shifts, regardless of the type of fluid aspirated. Clinically relevant aberrations in electrolyte concentrations are not usually found. However, hyponatremia and hypernatremia have been reported following the ingestion of large amounts of fresh or salt water. Rapid volume expansion may be indicated using isotonic crystalloid (20 mL/kg) or colloid. Inotropic support may be required using dopamine and/or dobutamine.

Most acidosis is restored after improved oxygenation and correction of volume depletion. Hypothermia may be present and exacerbate hypoxemia, acidosis, and bradycardia.

Normalization of cardiovascular function is ideal for neuroresuscitation. Vasoactive infusions may be efficacious in treating myocardial dysfunction and abnormal peripheral vascular resistance; however, the need for extended cardiovascular support is rare. Overall, treatment goals are aimed at normalization of blood pressure, maintaining organ perfusion, and facilitating gas exchange.


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