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Elevated Cerebrospinal Fluid Sodium and Chloride Levels in a Saltwater Drowning Death

Garland, Jack BMed*; Philcox, Winston BHSc; Kesha, Kilak MD; McCarthy, Sinead MBChB, DTM&H; Lam, Leo (Chi Sing) MBChB§; Palmiere, Cristian MD; Hensby-Bennett, Sarah MBChB, BSc(Hons); Stables, Simon MBChB, MNZM, DAvMed, AsFACAsM, FNZSP, FRCPA; Tse, Rexson MBBS, BSc, FRCPA

The American Journal of Forensic Medicine and Pathology: January 17, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PAF.0000000000000464
Case Report: PDF Only

To ascribe a cause of death from drowning in a body immersed in water can be difficult because of the absence of specific postmortem findings and unreliable ancillary tests. Postmortem vitreous biochemical analysis is documented to be a useful adjunct ancillary test to aid the diagnosis of saltwater drowning. A major confounding factor in using postmortem vitreous is the effect of electrolyte diffusion and water osmosis during immersion. A recent animal study suggested that cerebrospinal fluid (CSF) biochemical analysis, which is unaffected by immersion, may be an alternative. However, to date, there are no human data to support this. We report a saltwater drowning death from presumed suicide in which the postmortem CSF sodium and chloride level was elevated compared with nonimmersion deaths. This case gives evidence to support the potential use of postmortem CSF sodium and chloride level as an adjunct to the diagnosis of saltwater drowning.

From the *Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia;

Faculty of Medical and Health Sciences, University of Auckland; and

Departments of Forensic Pathology and

§Biochemistry, LabPLUS, Auckland City Hospital, Auckland, New Zealand;

CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland; and

Waikato District Health Board, Hamilton, New Zealand.

Manuscript received November 7, 2018; accepted December 8, 2018.

The authors report no conflict of interest.

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

© 2019 by Lippincott Williams & Wilkins.