Electrolytes Imbalance in Saltwater Near-Drowning Victims in the Gulf of Thailand

Somchai Yongsiri MD*, Pakapan Dinchuthai MD*, Jiranuch Thammakumpee MD**, Suriya Prongnamchai MD*, Rachaneeporn Chueansuwan MD*, Siriporn Tangjaturonrasme MD*, Pechngam Chaivanit MD*

Affiliation : * Faculty of Medicine, Burapha University, Chonburi, Thailand ** Internal Medicine Department, Chonburi Hospital, Chonburi, Thailand

Background : Near-drowning victims in saltwater are expected to have multiple electrolytes imbalance that affected treatment outcome. There are limited data about these parameters in Thailand to guide the treatment plan.
Objective : To study the characteristic of electrolytes imbalance in saltwater near-drowning victims in the Gulf of Thailand. Material and Method: Retrospective analytic study of 39 medical records of near-drowning patients admitted to Burapha University Hospital between 2000 and 2010. Characteristics of the patients and serum electrolytes were analyzed by SPSS version 19 for windows.
Results : The study included 23 male, 16 female patients. Average age was 14.4611.15 years and 19/39 (48.72%) patients were aged 10 or less. The following electrolytes imbalance were identified, hypokalemia 8/39 (20.51%), hypernatremia 12/39 (30.77%), hyperchloremia 15/39 (38.46%), high anion gap 23/39 (58.97%), and hypobicarbonatemia 28/39 (71.79%). Seven out of eight patients in the hypokalemia group were in the high anion gap group. Mean SpO2 in the patients who had high anion gap was significantly lower than those who had normal anion gap (87.0617.68% vs. 95.85.94% p = 0.031) without difference in systolic blood pressure (112.5914.63 vs. 105.6713.98 p = 0.159). Those who were hypotensive significantly had lower bicarbonate (17.003.51 vs. 20.593.81 p = 0.038) and higher anion gap (19.291.799 vs. 16.256.25 p = 0.025) than normotensive patients.
Conclusion : Hypobicarbonatemia, high anion gap, hypernatremia, and hypokalemia were common in saltwater near-drowning patients in the Gulf of Thailand. The cause of high anion gap was probably due to hypoxia and hypotension.

Keywords : Saltwater near-drowning, Electrolytes imbalance, Hypernatremia, High anion gap, Gulf of Thailand

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