Deaths in bathtubs in Japan: Forensic and clinical implications

Hypercalcemic Crisis Complicated With Acute Respiratory Distress Syndrome Due to Hot Spring Drowning: A Case Report

Hypercalcemia is generally treated conservatively, including massive fluid administration. However, in cases of acute respiratory distress syndrome (ARDS) associated with drowning, excessive fluid administration may worsen respiratory status. An 81-year-old female was found drowned in a hot spring at an accommodation facility and urgently transported to our hospital. On arrival, the patient exhibited severe respiratory failure, impaired consciousness, and bilateral lung infiltrates on computed tomography (CT), suggesting ARDS. Blood biochemical tests showed calcium (Ca) of 17.4 mg/dL, with altered consciousness attributed to hypercalcemia. Because of concerns about further deterioration of respiratory status, hemodialysis was performed to avoid massive fluid administration. Post-hemodialysis, blood calcium levels quickly decreased, leading to improved consciousness and respiration; the patient was extubated 48 hours post-admission. Subsequent examinations identified hot spring water aspiration as the cause of hypercalcemia. For hypercalcemia from hot spring drowning with acute respiratory distress syndrome, consider early hemodialysis initiation without excessive fluid administration.

Ambient Temperature and External Causes of Death in Japan from 1979 to 2015: A Time-Stratified Case-Crossover Analysis

BACKGROUND

Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the risks of temperature on external causes of death.

OBJECTIVES

We investigated the short-term associations between temperature and external causes of death and four specific categories (suicide, transport, falls, and drowning) in 47 prefectures of Japan from 1979 to 2015.

METHODS

We conducted a two-stage meta-regression analysis. First, we performed time-stratified case-crossover analyses with a distributed lag nonlinear model to examine the association between temperature and mortality due to external causes for each prefecture. We then used a multivariate meta-regression model to combine the association estimates across all prefectures in Japan. In addition, we performed stratified analyses for the associations by sex and age.

RESULTS

A total of 2,416,707 external causes of death were included in the study. We found a J-shaped exposure-response curve for all external causes of death, in which the risks increased for mild cold temperatures [20th percentile; relative risk (RR)=1.09 (95% confidence interval [CI]: 1.05,1.12)] and extreme heat [99th percentile; RR=1.24 (95% CI: 1.20, 1.29)] compared with those for minimum mortality temperature (MMT). However, the shapes of the exposure-response curves varied according to four subcategories. The risks of suicide and transport monotonically increased as temperature increased, with RRs of 1.35 (95% CI: 1.26, 1.45) and 1.60 (95% CI: 1.35, 1.90), respectively, for heat, whereas J- and U-shaped curves were observed for falls and drowning, with RRs of 1.14 (95% CI: 1.03, 1.26) and 1.95 (95% CI: 1.70, 2.23) for heat and 1.13 (95% CI: 1.02, 1.26) and 2.33 (95% CI: 1.89, 2.88) for cold, respectively, compared with those for cause-specific MMTs. The sex- and age-specific associations varied considerably depending on the specific causes.

DISCUSSION

Both low and high temperatures may be important drivers of increased risk of external causes of death. We suggest that preventive measures against external causes of death should be considered in adaptation policies. https://doi.org/10.1289/EHP9943.