Crit Care & Shock 2003 Vol. 6, No. 3 167 Crit Care & Shock (2003) 6: 167 - 171 Introduction Despite the high incidence of drowning and near- drowning accidents (~10-43 per 100,000 annually) [1], fluid and electrolytes disorders occurring in such con- ditions are rare [2]. Among the spectrum of electrolyte and fluid derangement encountered in near-drowning, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) predominates as a consequence to the hypoxic brain insult of underwater submersion. Strangely, central diabetes insipidus (DI) is an ex- tremely rare sequela of near-drowning patients despite being a relatively common complication of hypoxic brain injury occurring in other contexts such as head trauma. A literature search using the Medline over the last 34 years did not reveal any case reports/series of central DI secondary to near-drowning. We describe a young near-drowning victim who developed central DI, which required desmopressin for control. Central Diabetes Insipidus Complicating Near-Drowning Melvin K.S. Leow, Dessmon Y.H. Tai, Gilbert K.F. Lau Abstract Central diabetes insipidus (DI) is a very rare sequela of near-drowning. We report this case to add to the limited existing knowledge of this highly unusual complication in this group of pa- tients. A young female rescued from fresh water submersion developed polyuria associated with hypernatremia 4 days after the accident. Desmopressin (DDAVP) was used to control the inappropriate diuresis and stabilize her intravas- cular volume and tonicity. Despite satisfactory re- Case Report A 10-year-old girl with a history of bronchial asthma was rescued after being submerged for about 5 minutes in a fresh water swimming pool on the 4 July 1999. As she was found to be pulseless and cyanosed, cardiopulmonary resuscitation was initiated by her fa- ther immediately and continued uninterrupted for 20 minutes by a doctor from a private clinic nearby be- fore being managed by the ambulance paramedical team. The total time elapsed between her extrication from the pool to the arrival at the emergency depart- ment of a local hospital was approximately 30 min- utes. She was intubated and ventilated. The cardiac monitor revealed ventricular fibrillation. Sinus rhythm was eventually restored after electrical defibrillation. She was then transferred to the intensive care unit af- ter stabilizing her hemodynamically with inotropic support. Clinically, she was comatosed (Glasgow coma scale, GCS = 3/15) and her pupils were fixed and di- lated. Oculocephalic, corneal and gag reflexes were absent, and she exhibited no response to nociceptive external stimuli. She was profoundly hypothermic at 32.9° C. Her blood pressure was 95/45 mm Hg while on dopamine infusion and she had sinus rhythm of 80/ min. Chest examination revealed dual heart sounds and bilateral widespread coarse crepitations. There was no evidence of cephalohematoma or signs of external in- Registrar in Endocrinology, Endocrine Unit, Department of General Medicine, Tan Tock Seng Hospital, Republic of Singapore (Dr. Melvin K.S. Leow), Se- nior Consultant and Director, Medical Intensive Care Unit, Department of General Medicine, Tan Tock Seng Hospital, Republic of Singapore (Dr. Dessmon Y.H. Tai) and Consultant Forensic Pathologist/Deputy Director, Centre for Forensic Medicine, Health Sciences Authority, 11 Outram Road, Singapore, Republic of Singapore (Dr. Gilbert K.F. Lau). Address requests for reprints to: Melvin K.S. Leow, MBBS, MMED(Int Med)., Endocrine Unit, Department of General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. E-mail: melvin_leow@ttsh.com.sg sponse to DDAVP, she remained in a comatose state and cardiac arrest supervened 18 days af- ter the accident. Central DI should be considered in near-drowning patients with polyuria, and needs to be treated even in those with a dismal prognosis as this would facilitate the diagnosis of brain death. This might be of relevance to com- munities and medical institutions where the law- ful procurement of human organs in optimal con- ditions for transplantation is a clinical priority.