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[DYSPHAGIA] Aspiration of water


  • Subject: [DYSPHAGIA] Aspiration of water
  • From: icampbell-taylor@excite.com (irene campbell-taylor)
  • Date: Sat, 15 Sep 2001 13:23:36 -0700 (PDT)

There was another question about aspiration of water recently and I believe
I referred the writer to the near drowning literature. I realized that it
may not be easy for some to gain access to so I have added some of the most
critical information.
In addition, there are multiple articles on the safety of aspiration of
barium (alone, that is, NOT mixed with food) because, up until about 1965
when new technology appeared, bronchograms were done by injecting barium
directly into the lung. If barium liquid is safe, it follows that aspiration
of water, especially in the amounts likely to be aspirated when drinking a
glass of water, is equally innocuous. As long as the mouth is not diseased,
of course, nor the patient seriously immunocompromised, but then aspiration
of saliva is much more dangerous anyway.

ASPIRATION OF WATER

NEAR DROWNING

Definition and Epidemiology
 
Drowning is defined as death resulting from asphyxia due to submersion in a
liquid medium within 24 hours of the incident.  Near-drowning refers to
survival for more than 24 hours.

Pathophysiology
 
The sequence of events during drowning starts with the initial panic stage,
small amounts of water enter the hypopharynx causing apnea and laryngospasm.
Then large amounts of fluid are swallowed, struggling continues, then
gasping, loss of consciousness, emesis, and aspiration. Laryngospasm may
persist until death in 10% of the cases, causing what is referred to as dry
drowning.

Neither freshwater nor saltwater drownings have demonstrated a significant
problem with either electrolyte imbalance nor hemolysis. 
However, saltwater drownings will cause more pulmonary edema, whereas
freshwater drownings will cause more pulmonary damage due to impurities in
the water.

CNS damage that occurs is due to hypoxia and ischemia.

The most striking derangement is from hypoxemia both during the
near-drowning event and afterwards.  Hypoxia can occur with aspiration of as
little as 2.2 ml/kg of fluid. ( A person weighing 60kg would have to
aspirate 132ml of water for hypoxia to occur).

Treat pneumonia only if it occurs, acquiring sputum gram stain and culture
before implementing therapy.  Remember there is a good possibility of
encountering unusual organisms.






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