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  1. LOUISE DENVIR,
  2. MIKE POLKEY,
  3. DIPAK KANABAR
  1. Departments of Paediatrics and Respiratory Medicine, Guy's Hospital, St Thomas' Street, London SE1 9RT, UK

http://dx.doi.org/10.1136/adc.84.2.164

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    A previously fit and well 15 year old suffered a near drowning episode in seawater.

    Her initial blood gas was: pH 7.04, pco 2 12.2 kPa, po 2 8.97 kPa, HCO3 24 mEq/l, BE −10.

    Her spirometry, carried out on day 10, and subsequently, showed both a restrictive and obstructive picture.

    Her chest x ray was as shown in fig1.

    Figure 1
    Figure 1

    Questions

    1.
    What is the differential diagnosis on the basis of the x ray and the lung function tests?
    2.
    Nursing staff who suctioned her, noted sand in suction catheters while she was ventilated. What investigations would be appropriate next?
    3.
    What is the management of this condition and how common is it?

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      BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
      Archives of Disease in Childhood 2001; 84 0-0 Published Online First: 01 Feb 2001. doi: 10.1136/adc.84.2.0