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

Journal Reading

AbstractAn 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