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Elevated Postmortem Vitreous Sodium and Chloride Level in a Salt Water Drowning Death During Self-Contained Underwater Breathing Apparatus Diving With Diving Mask in Place

Case Report

Tse, Rexson, BSc, MB, BS, FRCPA*; Garland, Jack, BMed; Kesha, Kilak, MD*; Morrow, Paul, MD*; Elstub, Hannah, BSc, MB, BS‡§; Cala, Allan, FRCPA‡§; Spark, Amy, MBChB, FRCPA; Stables, Simon, MNZM, MB, ChB, DAvMed, AsFACAsM, FNZSP, FRCPA*; Sage, Martin, BSc, MBChB, PhD, FRCPA, DipForensPathol

The American Journal of Forensic Medicine and Pathology: September 2018 - Volume 39 - Issue 3 - p 247–249
doi: 10.1097/PAF.0000000000000390
Case Reports

Elevation of postmortem vitreous sodium and chloride (PMVSC) levels in salt water drowning (SWD) is hypothesized to result from electrolyte changes in blood from salt water inhalation/ingestion during drowning. After approximately 1 hour after death, electrolytes may diffuse into the vitreous humor via the eye coverings. This hypothesis was based on a study where bovine eyeballs were immersed in salt water. There is no human study that could confirm that SWD would result in an initial elevation of PMVSC with no effects from immersion. We present an SWD during self-contained underwater breathing apparatus diving in which the face mask remained in its correct position while the deceased was underwater. The face mask would have prevented the orbits from being in direct contact with salt water and therefore stopped any effects of immersion on PMVSC. The PMVSC was 294 mmol/L, above control levels, and the reported cut-off of 259 mmol/L for a diagnosis SWD. The elevated PMVSC would unlikely be owing to immersion but SWD. This case report supports the observation that during SWD PMVSC would initially increase from salt water inhalation and ingestion and not from immersion.

From the *Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand;

Hornsby Ku-Ring-Gai Hospital, Hornsby;

Department of Forensic Medicine,

§Forensic and Analytical Science Service, NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia;

Wellington Hospital Mortuary, Wellington; and

New Zealand National Forensic Pathology Service, New Zealand.

Manuscript received November 27, 2017; accepted January 10, 2018.

The authors report no conflict of interest.

Reprints: Rexson Tse, BSc, MB, BS, FRCPA, Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand. E-mail:;

© 2018 by Lippincott Williams & Wilkins.