What is Secondary Drowning?

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  • Written By: Mary McMahon
  • Edited By: C. Wilborn
  • Last Modified Date: 11 February 2020
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In 2008, a ten-year-old boy in South Carolina died in his bed an hour after swimming in a pool for the first time. His death was attributed to a phenomenon known as secondary drowning. This condition can be difficult to recognize, since the victim initially appears to be OK after a near-drowning incident. In some cases, however, enough water has entered the lungs to cause a drop in blood oxygen levels, and death may occur between one and 48 hours later. This condition is sometimes confused with dry drowning, in which a laryngospasm causes suffocation.

Contrary to popular belief, drowning does not necessarily involve a wholesale ingestion or aspiration of water or other fluids. During cases of secondary drowning, very little fluid is actually present in the victim's lungs. This small amount of liquid is still enough to make the lungs no longer able to deliver life-sustaining oxygen to the bloodstream, however, and the victim eventually succumbs to the lack of oxygenated blood. Death is generally attributed to a pulmonary edema, similar to the effects of acute pneumonia or wet drowning.


One thing which makes this condition so difficult to detect is its slow acting nature. A victim may breathe in a very small amount of fluid and believe he or she has successfully expelled it through coughing. In reality, the water may fill up some of the oxygen-rich pores of the lungs, reducing the lungs' ability to oxygenate the blood as it passes through. The heart does not slow down appreciably during this process, so the victim can still walk and talk. The only symptoms may be a sudden change in personality or level of awareness as the blood oxygen level drops over time.

Victims may or may not feel the effects of secondary drowning immediately. Children and anyone who has experienced a near-drowning should be watched closely after leaving a swimming area. Vomiting or involuntary defecation immediately following a swimming session should be considered a red flag. A sudden change in personality or energy level, such as agitation or extreme lethargy, may be a sign of oxygen deprivation. If a child has inhaled water while swimming, he or she should be observed for several hours for signs of labored breathing or altered mental status. Successful treatment for victims depends on a swift response and a quick diagnosis by trained medical personnel.

Often confused with secondary drowning is a condition called dry drowning. Although this condition has a number of causes, it can occur in a near-drowning incident, when the larynx closes to prevent the person from inhaling water or other fluids; this reflex action is known as a laryngospasm. Ordinarily, this laryngospasm should only last 30 to 60 seconds, but in the case of dry drowning, it can continue for several minutes. Meanwhile, the diaphragm drops, creating a partial vacuum in the lungs. Instead of drawing in a breath of outside air, however, this action pulls more oxygen-starved blood into the lungs.


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Post 10

It can happen in any water. A small amount of water can get in the lungs and inflame them and then it will cause it to pull more fluid into the lungs or like it says, lower the oxygen levels. Any sudden inhalation of any liquids including drinks, can cause aspiration into the lungs.

Post 8

This can happen in any water situation, so yes it can happen in a bathtub.

Post 7

That doesn't really help there, StormyWind. While that does help drowning ("traditional" drowning), it does not help what is referred to as "secondary drowning." You could be supervising your child and they inhale water, possibly just a little, and then have issues later. While the gate and lock and fence is great advice, it's unnecessary on this post. Just saying.

Post 6

I have a (hopefully not) silly, but serious question: can this happen while in the tub? My 1 year old hates the bath, especially when we pour water over her hair.

I don't mean can this happen if she falls into the tub; I mean can this happen when water is poured over her head/face? It's not a lot, and I think when she "gasps" it's more because she's scared-- she's not inhaling water- but just wanted to make sure. Thank you!

Post 5

I breathed in two lungfuls of water yesterday. What are the symptoms of secondary drowning so I'll know if I need go the hospital?

Post 4

Does osmosis play a part in any of this?

Post 3

Death by asphyxiation (because of secondary drowning) can actually occur up to 72 hours after a near-drowning incident. The 72 hour time frame exists because that is how long it can take the body to recognize a problem and create a solution for it.

Post 2

Freshwater may be more dangerous than saltwater in secondary drowning. When fresh water enters the lungs it is pulled into the pulmonary circulation by the alveoli. This happens due to the low capillary hydrostatic pressure and high colloid osmotic pressure. As a result, the plasma is diluted and the hypotonic environment causes red blood cells to burst.

The bursting of the red blood cells causes the electrical activity of the heart to change. The red blood cell bursting also allows hemoglobin to be released into the plasma. This can accumulate in the kidneys resulting in acute renal failure.

Salt water drowning does not cause the uptake of inspired water into the vascular system because the salt water is hypertonic (has a higher osmotic pressure) to blood.

Post 1

To prevent any type of drowning, a fence or barrier should be placed around pools. The fence or barrier should be too tall for a child to easily climb. In addition, a gate with a lock should be placed on the fence or barrier. In order to keep children from unknowingly entering the pool area, keep the gate securely locked.

While pools can be great summertime staples, owning one brings about immense responsibility. To ensure the safety of children, be sure to install the proper barriers and always keep an eye out around the pool area.

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