Severe hypercalcemia and polyuria in a near-drowning victim

Hypercalcemic Crisis Complicated With Acute Respiratory Distress Syndrome Due to Hot Spring Drowning: A Case Report

Hypercalcemia is generally treated conservatively, including massive fluid administration. However, in cases of acute respiratory distress syndrome (ARDS) associated with drowning, excessive fluid administration may worsen respiratory status. An 81-year-old female was found drowned in a hot spring at an accommodation facility and urgently transported to our hospital. On arrival, the patient exhibited severe respiratory failure, impaired consciousness, and bilateral lung infiltrates on computed tomography (CT), suggesting ARDS. Blood biochemical tests showed calcium (Ca) of 17.4 mg/dL, with altered consciousness attributed to hypercalcemia. Because of concerns about further deterioration of respiratory status, hemodialysis was performed to avoid massive fluid administration. Post-hemodialysis, blood calcium levels quickly decreased, leading to improved consciousness and respiration; the patient was extubated 48 hours post-admission. Subsequent examinations identified hot spring water aspiration as the cause of hypercalcemia. For hypercalcemia from hot spring drowning with acute respiratory distress syndrome, consider early hemodialysis initiation without excessive fluid administration.

Severe Hypercalcemia due to Drowning in an Onsen (Hot Spring)

Hypercalcemia is generally caused by primary hyperparathyroidism, malignancies, and drugs. Herein, we report a case of severe hypercalcemia due to drowning in hot springs. A 55-year-old woman was found floating in a public bath at a hotel and was admitted to a nearby hospital. The patient was intubated because of hypoxia and shock, and noradrenaline was titrated. Computed tomography revealed bilateral aspiration pneumonia. Blood tests revealed hypercalcemia (serum total calcium [Ca]: 18.7 mg/dL). Hyperparathyroidism, malignancy, and drug-related factors were ruled out as the causes of hypercalcemia. In addition, the public bath in which the patient drowned contained high concentrations of Ca. We concluded that the reason for hypercalcemia was accidental ingestion of the hot spring water containing a high concentration of Ca through the gastrointestinal tract. In the case of drowning and hypercalcemia, the cause may be clarified by examining the components that were accidentally swallowed.

Acute kidney injury after near drowning: The way from the beach to hemodialysis

Acute kidney injury (AKI) occurs in many different situations and may have a variable prognosis influenced by clinical setting, underlying cause, and comorbidity. This is important because of the high mortality and morbidity risk affecting many people around the world. Near-drowning related AKI requiring hemodialysis is very seldom reported in literature. Although cardiovascular and respiratory disorders are more frequently seen after this entity, we aimed to emphasize this rare but dangerous complication in near-drowning patients.

Hypercalcemic crisis resulting from near drowning in an indoor public bath

Patient:

Male, 66

Final Diagnosis:

Hypercalcemic crisis

Symptoms:

Near drowning state

Medication:

—

Clinical Procedure:

—

Specialty:

Critical care medicine

Objective:

Challenging differential diagnosis

Background:

Hypercalcemic crisis, generally caused by malignancy or primary hyperparathyroidism, is a life-threatening emergency that can result in multi-organ failure. Lowering the patient’s calcium level immediately and determining the correct etiology are essential.

Case Report:

We report a case of hypercalcemic crisis with a novel etiology. A 66-year-old male presented to the emergency room in cardiac arrest with a ventricular arrhythmia after being discovered submerged in an indoor public bath. He underwent cardioversion and was emergently intubated. Computed tomography showed bilateral pulmonary edema, suspected from water aspiration. Laboratory data revealed severe hypercalcemia and mild hypernatremia. Following three days of continuous hemodiafiltration, serum Ca decreased to and remained within normal limits. We concluded the etiology of hypercalcemia was absorption of Ca resulting from aspirated water.

Conclusions:

Near drowning can be a cause of hypercalcemic crisis. For cases of near drowning, it is important to investigate the source of the aspirated water and consider electrolyte abnormalities in the diagnosis.

Unique drowning in an atypical medium: paraffin wax in the setting of a motor vehicle crash--case report and literature survey

Among the various modes of death due to asphyxiation, drowning is unique. Unlike other types of suffocation associated with occluding airway obstructions (i.e. choking and smothering); with drowning, there is typically filling and involvement of the majority of the tracheobronchial tree and aerodigstive tract. Although the usual drowning medium is water, it can also occur in other media. Moreover, although drowning sometimes occurs in the setting of a motor vehicle accident, an element of vehicular submersion or immersion is usually operative in such instances. The case presented here is that of a motor vehicle crash which resulted in drowning where no immersion of the vehicle occurred. Moreover, the drowning medium was paraffin wax, rather than water. Other cases in the literature of drowning in atypical media and also those which are reported in the concomitant presence of a motor vehicle accident are presented.