Dr KK Aggarwal
Recipient of Padma Shri
Actor Sridevi died of accidental
drowning in her hotel bath tub after losing consciousness, according to the
forensic report by the Dubai govt. on Monday. However, the report, which
carries the stamp of the "Ministry of Health UAE" and the director of
preventive medicine, Dubai, Dr Sami Wadie, does not state the cause of
unconsciousness.
Can accidental drowning occur medically?
Yes. Medical conditions can cause accidental drowning. Seizure disorders, which
can be first-onset episode, can cause accidental drowning. Alcohol and/or use
of illicit drugs increases risk of accidental drowning as it may affect
balance, coordination and judgment. Stroke, syncopal attack (heart attack) or undetected
primary
cardiac arrhythmia are other factors that can cause accidental drowning.
A gasping patient with ventricular arrhythmia will end up with drowning.
If there are no signs of
struggle, then ‘accidental drowning’ can be a medical opinion. It is up to the
police to accept this opinion or find it as a case of ‘homicidal drowning’ and
investigate any foul play.
Some salient facts on accidental
drowning
Drowning is the third most common cause of accidental death. A victim of drowning
can be revived by cardiopulmonary resuscitation (CPR) with rescue breathing.
Prolonged resuscitation, up to many hours, has been known to revive patients
with hypothermia and cardiac arrest.
Antemortem drowning can be identified by the presence of fine, white, leathery,
copious froth or foam tinged with blood at the mouth and nostrils (Froth is of
lasting nature and large in quantity), cadaveric spasms in hands, diatoms
in tissues from brain, liver and bone marrow of long bones, presence of water
in stomach and intestines, voluminous water logged lungs along with fine froth
in lungs and air passages.
A bathtub drowning is a major cause of death in a bathtub. The bathtub is
the most common site of seizure-induced drowning; hence, patients with epilepsy
should be advised to take showers instead of baths. Heart attack leading to
syncope and subsequent falling in the tub can cause drowning. Besides the
causes discussed above, mutations in the cardiac ryanodine receptor (RyR)-2
gene, which is associated with familial polymorphic VT in the absence of
structural heart disease or QT prolongation, have been identified in some
individuals with unexplained drowning. Concomitant trauma, paralysis, heart
attack or hypothermia, which can lead to rapid exhaustion or cardiac arrhythmias
are other factors for accidental drowning. Duration of submersion >5 minutes
is the most critical factor.
Several studies have reported incidents of bath tub drowning with varying
medical histories as follows:
·
A total of 268 victims were found unconscious or dead during tub bathing.
After postmortem examination, the manner of death was judged as natural cause
in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Drowning water
inhalation, which was confirmed in 72% of victims, was absent in the others.
Whereas, inhalational findings were more frequent in victims with other
backgrounds such as alcohol intake, mobility disturbance, and history of
epilepsy (Am J Forensic Med Pathol. 2013 Jun;34(2):164-8).
·
In a series of 14 cases of suicide by drowning in the bath in the Bristol
area, England between 1974 and 1996, six cases had evidence of concomitant
alcohol or substance use. Seven cases had a past psychiatric history and a
history of previous deliberate self-harm. Most drowned at home, face down,
fully clothed (Med Sci Law. 1999 Oct;39(4):349-53).
·
A retrospective review of 92 deaths in the bathtub in Maryland found 71.7%
incidence of bathtub drowning; 28.3% were the absence of bathtub drowning.
Three leading contributory causes of death were cardiovascular disease,
drug/alcohol-related death, and seizure disorder in both groups More than
triple overlapped drowning-related signs (history of recovery from the water,
foam in the air way, watery fluid in the sphenoid sinuses, hyperinflated lungs
and watery fluid in the stomach contents) could be beneficial for the diagnosis
of a bathtub drowning. (Forensic Sci Int. 2015 Aug;253:64-70).
·
In a retrospective analysis of 245 bathtub death cases between 1971 and
1988 carried out in the Institute of Legal Medicine in Hamburg, 66 cases proved
to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as
homicides, while 51 fatalities remained unclear with respect to one of these groups.
About 50% of the victims were alcoholized. (Arch Kriminol. 1991
Jul-Aug;188(1-2):35-46).
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care
Foundation of India
Immediate Past National
President IMA
