A Houston boy who went swimming at Texas City Dike over Memorial Day Weekend died days later from reportedly “dry drowning,” or possible “secondary drowning.”
“Dry Drowning” sometimes gets confused with secondary drowning. The latter occurs when fluid gets into the lungs when one swims and hours, or days later (out of the water), causes respiratory failure. As will be discussed below, dry drowning causes a spasm of the vocal cords which inhibits breathing.
Frankie, 4 years old, appeared fine until a few days later, his father, Francisco Delgado, Jr., said he appeared to be suffering from a minor, stomach ailment. Then one morning the boy woke up with shoulder pain, and “Out of nowhere, he just woke up. He said ahhh.” His father told KTRK, “He took his last breath and I didn’t know what to do no more.”
Despite efforts by paramedics and the parents, Frankie passed. A GoFundMePage has been created for the family to help with funeral expenses.
Dry Drowning occurs when water touches the first pass of the respiratory tree, one’s vocal cords, larynx. When water touches this area a reflex is triggered, causing a spasm (laryngospasm) such that the vocal cords constrict and close up the airway. It's a defense mechanism designed to prevent water from falling into the lungs. However, laryngospasm causes immediate hypoxia, lack of oxygen, and if not reversed, the victim will die. In dry drowning, water never officially reaches the lungs.
In Secondary Drowning, water gets inhaled and sits in the respiratory tree and if uncleared through coughing, will sit and prevent proper oxygenation. Moreover the water will irritate the lung linings causing more fluid and inflammation, resulting in pulmonary edema. This could occur hours to days after the water activity.
According to Florida Hospital Tampa pediatrician, Dr. James Orlowski, these events are very rare, comprising only 1-2% of drowning incidents.
The symptoms for both “Dry” and “Secondary Drowning” are similar in which the victim could have any of the following:
to name a few…
Horse play in water should be avoided. This includes bathtubs, plastic pools, hot tubs, pools, lakes, ocean, etc.
Never swim alone.
Swim in areas staffed with lifeguards and/or appropriate supervision. If water does get inhaled watch the child or adult to look for any of the above symptoms. If concerned seek medical help immediately.
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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.
For centuries, multiple civilizations have used cannabis to treat various medical conditions, including seizures. This week researchers from NYU Langone’s Comprehensive Epilepsy Center found a chemical in marijuana to do just that.
A study published in the New England Journal of Medicine found that a liquid medication containing cannabidiol, one of the many chemicals in marijuana, reduced convulsive seizures in children by half.
Created by GW Pharmaceuticals, Epidiolex, brand name, was the drug used in this study and has not yet received FDA approval.
As opposed to THC, tetrahydrocannabinol, the psychoactive ingredient in marijuana, cannabidiol does not cause euphoria and has been the subject of many studies for its medicinal applications.
In this study, researchers tested 120 children with Dravet’s syndrome and found those given Epidiolex not only suffered less seizures, but 5% of the children were seizure-free during the 14 week trial.
Side effects, however, were reported such as fatigue, vomiting, diarrhea and anorexia (loss of appetite).
A seizure occurs when there is abnormal electrical activity in the brain. If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.
Epilepsy is a neurological disorder in which a person has recurrent, unprovoked seizures.
Dravet Syndrome is a rare genetic condition that starts in infancy. Children can suffer a variety of seizures and may eventually suffer from developmental delay and learning disorders. What makes Dravet Syndrome so severe is the fact that the seizures are refractory to many anti-seizure medications.
More research needs to be done in this area, but these preliminary findings give parents and the medical community hope that a pharmaceutical option could exist in the near future for these devastating and potentially fatal seizures.
Multiple states in the US currently allow recreational marijuana or medicinal use of cannabis and multiple more states may be following suit in upcoming elections.
Even those who support the legalization have concerns over driver safety and how to determine if one is impaired.
Breathalyzers are currently being developed and tested but are not ready for roadway spot checks. Moreover, breathalyzers may have difficulty accurately detecting both inhaled and ingested marijuana.
California law enforcement officers are piloting road-side saliva tests but objective data is still lacking regarding the accuracy of oral fluid tests.
Currently when law enforcement tests an impaired driver for marijuana use, a urine test can be performed which only looks for a metabolite called THC-COOH. Despite its abbreviation it is a non-psychoactive component of marijuana, as opposed to delta-9-tetrahydrocannabinol (delta-9-THC), which does cause euphoria. Hence the shortcoming to this testing method are twofold, as the non active THC-COOH isn’t even the correct metabolite to measure intoxication and it can linger in the body for weeks, hence not allowing an adequate quantitative measure to determining one’s impairment.
Two medical students, however, figured out what needs to be tested and how. Graham Lambert and Charles Cullison, both entering their third year at Touro University Nevada, performed research for an American College of Legal Medicine (ACLM) poster contest.
One of the lead researchers and osteopathic medical student Graham Lambert said, “This is an issue because it’s non-psychoactive. It stays in the body for long periods of time, long after any psychoactive effects.” Their research lead them to conclude that testing should instead look for an alternate THC metabolite, 11-OH-THC.
Why? Let’s break this down. Now both delta-9-THC and 11-OH-THC are psychoactive compounds that can be tested in the blood. However law enforcement has to determine whether euphoria was present and a factor in one’s unlawful driving. Both delta-9-THC and 11-OH-THC crosses the blood brain barrier, a semi-permeable endothelial cell barrier that helps decide what substances can enter and leave the brain. But 11-OH-THC’s is more readily active and can bind to the brain’s cannabinoid receptors tighter, lasting longer and causing more of a psychoactive effect.
Additionally, 11-OH-THC is a metabolite also seen in high quantities after ingesting marijuana edibles.
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In 2012, Sharma et al found the 11-OH-THC to last twice as long in the blood than delta-9-THC, which would make sense due its strong binding properties. Yet the psychoactive 11-OH-THC will rapidly be metabolized to an inactive form hence its presence on a test will signify activity rather than just “hanging around”.
Once Lambert and Cullison determined this, they went to Assemblyman Steve Yeager, D-Las Vegas, who is Chair of the Assembly Judiciary Committee. Yeager helped sponsor a bill, AB135 that would convert marijuana testing for drivers from the inaccurate urine test to a blood test that would look for specifically 11-OH-THC.
Also lead researcher and osteopathic medical student, Charles Cullison said, “Blood alone accurately shows the levels of hydroxy (11-OH-THC) and marijuana.”
In regards to getting the bipartisan law passed through the State Senate with a “Veto-less” majority, Cullison stated, “We couldn’t have done this without the help of many people.”
After Nevada lawmakers passed AB 135, Governor Brian Sandoval signed it into law. The antiquated urine testing will not be used to test drivers pulled over for possible DUI but a blood test instead.
The legal limit of marijuana that is measured in nanograms per milliliter ng/ml would be 2 ng/ml for delta-9-THC and 5 ng/ml for 11 Hydroxy-THC. This does not change with passage of AB135, nor do the circumstances surrounding when to test, as current protocols are in place once a person fails his sobriety test.