Ethanol intoxication impairs judgment, orientation, reflexes, and motor activity, leading to an impaired ability to deal with an unexpected situation (8,12,108,134). Impairment is observed even when the blood alcohol concentration is low (20 mg/dL or 4.3 mmol/L [108]). The risk of accident increases for all persons when the blood alcohol concentration reaches 50 mg/dL (11 mmol/L [108]). Alcohol may enhance certain respiratory tract reflexes (e.g., laryngospasm), triggered by exposure to water, which contribute to "dry drowning" (see Subheading 4.3. and refs. 76, 110, and 134). Alcohol consumption without ingestion of food, coupled with strenuous activity, leads to hypoglycemia and impaired thermoregulation (108,135,136). The increase in cutaneous temperature from vasodilation leads to an increased temperature gradient between skin and water and a more pronounced stimulation of cold receptors (17). This may enhance cardiorespiratory reflexes, increasing the possibility of arrhythmia and sudden uncontrollable breathing (see Subheading 4.5. and ref. 17).

Fig. 2. Woman found drowned in bathtub. Scene investigation revealed empty sleep-aid bottle. Toxicological analysis showed elevated but nonfatal diphenhydramine level.

Various studies of adolescents and adults drowning in different situations have shown that about 40 to 60% have toxicological evidence of ethanol ingestion (11,12,18, 32,33,38,41,108).

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