A Case of Drowning with Acute Kidney Injury and Raised Intracranial Tension

Drowning is the third leading cause of unintentional injury and death worldwide, accounting for 7% of all injury-related deaths. People who are at higher risk include those who have free accessibility to water and younger children lacking supervision. The common complications of drowning are mainly due to hypoxia. It mainly affects the respiratory, cardiac, and central nervous system. Rarely, drowning may cause acute kidney injury (AKI) secondary to rhabdomyolysis. Here, we present a case of near drowning with AKI, rhabdomyolysis, and elevated intracranial tension (ICT) with a false localizing sign (abducent nerve palsy).

A 21-year-old female patient was brought with a history of alleged drowning for about 3-5 minutes. The patient presented with loss of consciousness; she was gasping and had diffuse subcutaneous emphysema. On examination, the patient had bilateral coarse crepitations. She was started on mechanical ventilation. After 2 days, the patient developed elevated renal parameters and had an episode of ventricular tachycardia. After 10 days, the patient developed diplopia and blurring of vision. Ophthalmological examination revealed bilateral abducent nerve palsy with established papilledema and hemorrhagic retinopathy. The patient was treated with IV antibiotics, IV fluids, DC shock, inotropes, hemodialysis, and acetazolamide. After 15 days, the patient recovered from bilateral lateral rectus palsy and had no blurring of vision.

Drowning is a leading cause of accidental death. This patient had diffuse subcutaneous emphysema, rhabdomyolysis with AKI, ventricular tachycardia, and raised ICT. In drowning, raised ICT often has a poor outcome. However, with constant monitoring and timely intervention this patient survived.