Secondary drowning in a patient with epilepsy

Drowning is defined as death by suffocation after submersion in a liquid; near drowning is survival, at least temporarily, after aspiration of fluid into the lungs.1 2 Secondary drowning is death or serious clinical deterioration following near drowning after a period of relative wellbeing; it is not due to neurological causes, respiratory sequelae of inhaled foreign material, or secondary infection. Secondary drowning is caused by inadequate alveolar gas exchange, probably due to primary alveolar membrane dysfunction and loss of surfactant. It can happen after immersion in fresh water or salt water.3^–5 Secondary drowning occurs in 2-5% of all submersion incidents.6 7

We report a patient who seemed to recover fully from near drowning. The diagnosis of secondary drowning was not made until several hours after admission with acute respiratory distress. We highlight the need to consider secondary drowning and describe its immediate care, diagnosis, and management.