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ARTICLE CONTRIBUTORS

Medicine, Science and the Law, Royal Society of Medicine

Clinical Articles, Lead Article

DON’T SWIM ON A FULL STOMACH

Food intake may be an important factor in accidental drowning, according to a study1 published in the latest issue of Medicine, Science and the Law. Warnings about not eating before swimming are common, with a prohibition on swimming after eating ranging from 20 minutes to as long as three hours. But up until now, there has been little evidence to support the relationship between food intake and accidental drowning.

“The study highlights what we have always suspected and seen on a case by case basis,” said Professor Peter Vanezis, Editor of Medicine, Science and the Law and Professor of Forensic Medical Sciences at Barts and the London, Queen Mary, University of London.

A team from the Department of Legal Medicine, at Tokyo Women’s Medical University, analysed 536 consecutive autopsies between April 2000 and December 2007. They examined autopsy reports, autopsy case files and police investigation reports to ascertain the manner of death. Where it was impossible to determine the exact cause of death, the death was classified as ‘undetermined’. For each death, the team recorded the blood alcohol level and whether or not stomach contents was present (defined as solid food residues identifiable with the naked eye).

Accidental drowning was the most common manner of death in which the presence of stomach contents was identified – 79% (27 out of 34 cases). There were 59 cases of undetermined death and these included eight drownings in the bath.  Death by drowning in a bath was classified as undetermined because of the difficulty in the determination between accidental drowning and natural death due to heart disease that happened to occur in the bath.  Of these eight drownings, seven cases involved a victim over the age of 69 and of these seven cases, five had stomach contents present.

Of the 111 cases of suicide, 51 included suicidal drowning and these cases were compared with the 34 victims of accidental drowning. Stomach contents was found significantly more often in those who died from accidental drowning than suicidal drowning (27 [79.4%] versus 22 [43.1%] cases). The researchers concluded that food intake before death is associated with accidental drowning but noted that further studies were required to assess, in particular, the relationship between the amount of stomach contents and the cause of death to determine whether fasting before swimming or bathing could help prevent accidental drowning.

The mechanism of death by drowning in those with a full stomach is thought to be either asphyxiation after aspirating of vomited stomach contents or circulation problems after blood is diverted to the intestine during digestion. The latter may result in decreased blood flow to the brain and subsequent loss of consciousness.  The authors note that alcohol consumption is known to be a significant contributory factor in accidental drowning.

References

1 Kibayashi K, Shimada R and Nakao K.  Frequent detection of stomach contents in accidental drowning. Med Sci Law 2011:1–3. doi: 10.1258/msl.2011.010150.

Published on: August 2, 2011

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