(Courtesy of Rambam Hospital) Rambam Hospital physicians have discovered that acute kidney injury is a common complication of near drownings, due to lack of oxygen and the fight-or-flight response. Their research points to men being at highest risk for this complication.
According to the World Health Organization, drowning is the third leading cause of accidental death globally, with males especially susceptible. Drownings along Israel’s Mediterranean beaches occur frequently, approximately 60 annually, higher than in other Mediterranean countries. This summer’s recent surge of fatal drownings brings home this dire statistic.
Physicians from Rambam Health Care Campus observed that a relatively high number of nearly drowned patients developed a sudden reduction in kidney function within days of hospital admission, with potentially fatal consequences. This is particularly challenging, since the kidneys are critical for health, removing wastes from the body while maintaining a healthy balance of water, salts and minerals in the blood. In 2016, a 31-year-old man who had been submerged in seawater for four minutes arrived at Rambam with water in his lungs, respiratory distress, elevated heart rate, low blood oxygen concentration and low phosphate levels; he subsequently developed acute kidney injury (AKI). This case study sparked research to investigate the frequency of AKI in near drowning victims, its clinical characteristics, warning signs and causes.
The research was led by Professor Mogher Khamaisi, a senior physician in the Department of Internal Medicine D and member of the Clinical Research Institute at Rambam, with the participation of Rambam physicians Drs. Yuri Gorelik and Said Darawshi, also from the Department of Internal Medicine D, and Hiba Yaseen from the Institute of Diabetes and Metabolism, in cooperation with Samuel Heymanat, head of the Department of Medicine at Hadassah Hebrew University in Jerusalem. Theirs was the largest and most comprehensive study researching the mechanism of kidney damage in near-drowning patients immersed in seawater to date; previous studies only looked at a few patients.
The Rambam physician-scientists reviewed medical records of 95 patients treated in Rambam from 2000 to 2017 who nearly drowned in the Mediterranean Sea; 43 patients (45 percent) developed AKI, 17 reaching an advanced stage of disease (stage 2/3) as indicated by a high increase in creatinine levels in the blood and reduced urine output. Creatinine levels normalized in the stage 2/3 group within 120 hours and in the stage 1 group within 72 hours. Patients with stage 2/3 AKI were more likely to require mechanical respiration and treatment in an intensive care unit (ICU) and had a higher mortality rate, often from multi-organ failure.
The researchers concluded that AKI is a common complication of near drowning associated with increased hospital mortality that may be more common in males. The main causes of kidney damage appear to be temporary lack of oxygen combined with the victims’ physiological fight-or-flight response—increased heart rate, very high blood sugar levels, constriction of the kidney blood vessels, reduced potassium levels and increased demand for oxygen.
The researchers recommend further studies on near-drowning patients at risk for developing AKI based on this research, and treating and monitoring patients by restoring oxygen levels throughout their body, maintaining proper dilation of kidney blood vessels and other medical practices to prevent kidney complications.
