Prolonged immersion usually results in inhalation of fluid; however, 10-20% of patients develop intense laryngospasm leading to so-called 'dry drowning'. Traditionally, fresh water drowning was considered to lead to rapid absorption of water into the circulation with haemolysis, hypo-osmolality and possible electrolyte disturbance whereas inhalation of hypertonic fluid from sea water drowning produced a marked flux of fluid into the alveoli. In practice, there seems to be little distinction between fresh and sea water as both cause loss of surfactant and severe inflammatory disruption of the alveolar-capillary membrane leading to an ARDS-type picture. Initially, haemodynamic instability is often minor. A similar picture often develops after 'dry drowning' and subsequent endotracheal intubation.

Acute hypothermia often accompanies near-drowning with loss of consciousness and haemodynamic alterations.

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