Forensic Medicine · Asphyxial Deaths (Mechanical Asphyxia, Drowning, Smothering)

Gettler's chloride test is applied to blood from both sides of the heart in a suspected drowning case. Which result supports FRESHWATER drowning?

  • A Chloride in the right heart exceeds the left by more than 5 mg percent
  • B Equal chlorides in both ventricles with raised serum sodium
  • C Chloride in the left heart exceeds the right by more than 5 mg percent
  • D Chloride less than 400 mg percent in both ventricles
Correct answer: C. Chloride in the left heart exceeds the right by more than 5 mg percent

Explanation

In freshwater drowning, aspirated hypotonic water is rapidly absorbed through the lungs into the pulmonary circulation, diluting the blood reaching the left side of the heart. Chlorides in the left heart therefore fall relative to the right, and a difference exceeding 5 mg per 100 ml is taken as evidence of drowning. In saltwater drowning the hypertonic medium pulls fluid out of the circulation, concentrating the right heart blood and raising its chlorides instead. The test loses validity in decomposed bodies where diffusion equalises both sides.

Reference: Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 6th ed.

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