Journal Reading

ORGAN WEIGHT EFFECTS OF DROWNING

AND ASPHYXIATION ON THE LUNGS, LIVER,
BRAIN, HEART, KIDNEYS, AND SPLEEN

By :
Aulia Urrachman S.
Chairatu Sadrina Djeni
Cut Nova Aprianti
Syarifah Chaula Amrina
Yusra
Pembimbing:
Dr. dr. H. Taufik Suryadi, Sp. F

Abstract
An examination of the organ weights associated with victims of drowning,
asphyxiation and trauma was undertaken to determine (a) the effects of asphyxiation
compared to a trauma group, and in turn, (b) the effects of drowning compared to an
asphyxiation group. Included in the study were 217 drowning deaths, 166 pure
asphyxiation deaths and 381 trauma deaths. The effects of asphyxiation (compared
to trauma) resulted in elevated mean organ weights for the lungs, liver, kidneys and
spleen (with mean increases of 17.8, 10.5, 10.3 and 23.4%, respectively). Effects of
drowning (compared to asphyxiation) resulted in elevated mean organ weights only
with the lungs and kidneys (with mean increases of 30.0 and 4.4%, respectively).
Only the mean heart and brain weight remained constant across all experimental
groups. A picture of drowning is suggested in which elevated lung and kidney
weights are the result of both asphyxiation and the aspiration of water that occurs
with drowning, whereas elevated spleen and liver weights in drowning victims are
associated with only the effects of asphyxiation. In addition, the common autopsy
finding of a small, anemic spleen in drowning, rather than caused by some
pathophysiological mechanism of death, is hypothesized to be a postmortem
phenomenon.

Introduction

One of the most common autopsy findings

in drowning cases is a heavy, edematous
lung in which cut surfaces exude large
amounts of fluid. This is assumed to occur
primarily as the result of water that is
aspirated into the lungs before death.

Introduction

Surprisingly, a comparison of lung

weight/body weight ratios across drowning
and asphyxiation groups did not find any
statistically significant effects. This result
suggests that the autopsy finding of an
edematous lung is not specific to drowning
per se, but is caused by mechanisms
associated with asphyxiation (or other
secondary effects).

Methods

First, only those autopsied drowning victims that

were found in either (a) outdoor, inland bodies of
water (91% of all cases), or (b) the brackish waters of
the Chesapeake Bay and its estuaries, were included
in the study.
Inclusion also depended upon (a) male gender, (b)
an age between 18 and 65, (c) white or black
ethnicity, (d) no contributing causes of death such as
trauma or epilepsy, and (e) no evidence of disease.
Finally, only those cases that were known to be
recovered from the water within 6 h of the drowning
incident were included in the study.

Methods

The following information was abstracted

from autopsies performed by forensic
pathologists at the Office of the Chief
Medical Examiner of the State of Maryland:
(a) height, (b) body weight, (c) combined
lung weight, (d) liver weight, (e) combined
kidney weight, (f) heart weight, (g) brain
weight, (h) spleen weight, and (i) evidence
of trauma and/or premorbid disease
involving the organs of interest.

Methods

First, an analysis of covariance (ANCOVA) was

conducted in order to compare the drowning and
asphyxiation groups for each organ type.
Second, the same ANCOVA was conducted in order
to compare asphyxiation and trauma groups.
If body weight and organ weight in fact vary
independently, the organ weight/body weight ratio
used by Ito et al. and Haffner et al. would create a
bias for (a) lower ratios in any groups that have
greater mean body weight and (b) higher ratios in any
groups that have lower mean body weight.

Result

In the ANCOVA intended to uncover

effects of asphyxiation, the asphyxiation
group showed significantly higher mean
weights than the trauma group for every
organ except the brain and heart.

Discussion

Because the aspiration of water in drowning is the only phenomenon that

differentiates a drowning death from a purely asphyxial death, the present
study confirms a significant role for this phenomenon in causing death by
drowning (that can increase blood volume by as much as 50% in fresh
water drownings).
Whereas edematous lung tissue in drowning victims is commonly
attributed to aspirated fluids prior to being drawn into the blood stream,
the present evidence suggests that this autopsy finding is also the
consequence of the back pressure on the lungs associated with
hypervolemia. Although death by drowning has been described as in part
due to cardiac failure resulting in the changes in blood chemistry with
haemodilution, it is possible that a sudden and large increase in blood
volume may also play a more direct role in the explanation of how death
occurs in drowning, that is, by a more rapidly developing pulmonary
edema.

The diagnostic value of these findings for forensic

pathologists is less straightforward. Because the range
of weights for a given organ were similar across trauma,
asphyxiation, and drowning groups, there becomes no
means to determine whether an organ weight is
elevated for a given individual, that is, without
knowledge of premorbid values. Even an edematous
lung, except for possibly the most severe cases of
edema (with combined weight greater than 2700 g),
cannot distinguish between drowning and asphyxiation
(e.g. as the result of suffocation before being dumped
in the water).

Conclusion

The result is a picture of drowning that includes

effects of asphyxiation with elevated weights for
the lungs, liver, kidneys and spleen, but with only
the lungs displaying any sizeable increases in
weight beyond that due to asphyxiation. An
important role for the aspiration of water (and
resulting hypervolemia) is therefore implicated to
explain how death occurs in freshwater drowning,
that is, by rapidly accelerating the occurrence of
pulmonary edema.

TERIMA KASIH