Near-drowning is rare in dogs and cats, but it can be life-threatening. New devices that allow veterinarians to quickly take images of the heart and lungs directly in the practice or hospital, as well as modern “artificial lung or kidney replacement systems” (ECMO, CVVH), will offer additional possibilities in the future, incorporating insights from human medicine. Only through these means can the survival rates and quality of life for affected dogs and cats be improved in the long term.
Drowning
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Near-drowning refers to a condition where an animal suffers respiratory impairment due to submersion in liquid but does not immediately die. During the drowning process, normal breathing is interrupted by the immersion of the airways in liquid. The pathomechanism is complex and varies depending on the type of liquid. In freshwater, hypotonic fluid enters the lungs and is rapidly absorbed into the blood, which can lead to hemolysis and electrolyte disturbances. In saltwater, however, the hypertonic fluid draws plasma from the blood into the lungs, leading to pulmonary edema. Both processes significantly impair gas exchange and lead to hypoxia.
The physiology of drowning follows a characteristic sequence: Initially, the airways close reflexively to prevent water from entering. This laryngospasm can last up to two minutes. Subsequently, the increasing CO₂ levels in the blood lead to an involuntary breathing reflex, causing water to enter the lungs. The resulting hypoxia leads to unconsciousness and ultimately to circulatory arrest if no rescue measures are taken.
For dogs and cats, it is particularly important to note that life-threatening complications can still occur even after apparent recovery, especially secondary drowning, where pulmonary edema can develop hours after the incident.
Causes
All animals can swim. However, if they end up in a body of water from which they cannot escape on their own, there is a risk that they may drown due to exhaustion (Fig.).
The causes of near-drowning in pets are diverse and strongly related to their living conditions and access to water bodies. Unsupervised access to pools, ponds, or other open waters is the most common cause. Animals with no experience with water are particularly at risk. Cats more often find themselves in distress as they are naturally less inclined to swim than many dogs.
Certain risk groups are particularly vulnerable: Brachycephalic (short-nosed) dog and cat breeds such as Pugs, French Bulldogs, or Persian cats have an increased risk of breathing problems in water due to their anatomy. Older animals with limited mobility or neurological conditions, as well as puppies and young animals without swimming experience, are also at higher risk.
Environmental factors also play an important role. Strong currents in rivers, cold water leading to rapid hypothermia, or ice covers on water bodies in winter pose specific dangers. Additionally, pre-existing health conditions such as epilepsy or heart diseases can lead to sudden unconsciousness in water.
An often underestimated factor is exhaustion: Even animals capable of swimming can drown if they cannot find a way out of the water or become exhausted due to panic. This occurs especially in pools with steep walls without exit aids.
Symptoms
- When submerging, the airways initially close reflexively to prevent water from entering the lungs.
- If the animal remains underwater for too long, this reflex stops. This leads to
- Swallowing large amounts of liquid.
- Due to an uncontrollable breathing reflex, water enters the lungs.
- A laryngospasm initially prevents much water from entering the lungs.
- When the spasm resolves, more fluid enters the lungs.
- Due to laryngospasm or increasing fluid in the lungs, gas exchange can no longer function properly.
- Unconsciousness, seizures, cardiac arrhythmias, weak pulse, and circulatory failure are the consequences.
- Death occurs after 3 to 5 minutes.
Even if the animal appears to have recovered from the incident, serious consequences, such as the development of pulmonary edema, can occur subsequently.
The symptoms of near-drowning in dogs and cats can be divided into acute and delayed signs. Immediately after the incident, the following symptoms may occur: coughing and gagging, rapid and labored breathing (dyspnea), bluish or pale mucous membranes (cyanosis), unconsciousness or severely reduced responsiveness, and vomiting of water or stomach contents. In severe cases, seizures, cardiac arrhythmias, and circulatory failure can occur.
Particularly insidious are the delayed symptoms that can develop hours after the incident. These include increasing shortness of breath, persistent coughing, lethargy and loss of appetite, elevated body temperature, and wheezing or gurgling breathing sounds. These signs may indicate secondary drowning, where pulmonary edema develops after the animal has already been rescued and initially appeared stable.
The severity of symptoms depends on various factors: the duration of submersion, the type of liquid (fresh or salt water), the water temperature, and the general health condition of the animal. Especially in cold water, hypothermia can mask symptoms and complicate diagnosis.
Pet owners should be aware that even animals that seem to have fully recovered after a water accident must be closely monitored, as life-threatening complications can still occur up to 24 hours after the incident.
First Aid
- Get your pet out of the water as quickly as possible, but protect yourself.
- Place your pet on its side so that the head is the lowest point, allowing any remaining water to drain well and preventing stomach contents from entering the airways.
- Open the mouth and gently pull the tongue forward. If your pet is not too heavy, you can hold it head downward. A gentle tapping massage on the chest by a second person helps drain fluid from the lungs.
- If your pet is not breathing, begin resuscitation. For drowning, resuscitation begins with ventilation, not chest compressions as is usually the case.
- Keep your pet warm using a blanket.
- If your dog has access to a swimming pool, teach it where there is a ladder or other possible exit for your dog.
Diagnosis
The diagnosis of near-drowning begins with the anamnesis, where the circumstances of the incident are questioned in detail. Important information includes the approximate duration of submersion, the type of water (fresh or salt water), the water temperature, and the time since the incident. In the clinical examination, the veterinarian pays particular attention to vital signs such as respiration, heart rate, mucous membrane color, and body temperature.
Auscultation of the lungs is crucial to identify crackles, wheezes, or muffled lung areas that may indicate pulmonary edema or aspiration. Pulse oximetry to measure blood oxygen saturation provides information about the severity of respiratory impairment.
Imaging techniques play a central role in diagnosis. Chest X-rays can detect fluid accumulations in the lungs, pulmonary edema, or aspiration pneumonia. In case of unclear findings, an ultrasound examination of the lungs can be used additionally to identify pleural effusions or consolidated lung areas.
Laboratory tests include a complete blood count to assess inflammatory reactions, blood gas analyses to evaluate acid-base balance and oxygenation, as well as electrolyte determinations, as electrolyte disturbances can occur especially with freshwater aspiration. If a bacterial secondary infection is suspected, a culture of tracheal secretions may be useful.
Even for animals that initially show no obvious symptoms, thorough diagnostics are important, as complications such as secondary drowning can develop hours after the incident.
Further veterinary measures
Even if your pet seems to be recovering, consult a veterinarian.
The veterinarian’s treatment will also focus on addressing cardiac and respiratory arrest, the resulting oxygen deficiency and its consequences for the brain, heart, and other organs, as well as treating potential hypothermia.
Inpatient treatment is advisable until all changes in the organism have been balanced.
Even patients with mild symptoms, radiologically unremarkable lungs, and good blood oxygen saturation should be monitored as inpatients for at least a few hours.
The veterinary treatment includes several components: Oxygen therapy is essential and can be administered via oxygen cages, nasal cannulas, or in severe cases through intubation and mechanical ventilation. Fluid therapy serves to balance electrolyte disturbances and stabilize circulation, with the type and amount of infusions needing to be individually adjusted.
If pulmonary edema develops, diuretics such as furosemide are used to remove excess fluid from the lungs. Bronchodilators can help widen the airways in cases of bronchospasm. Antibiotic therapy is indicated if a bacterial secondary infection is suspected. Analgesics and sedatives can be used for pain relief and calming.
Heat therapy is particularly important for animals that have had accidents in cold water, to treat or prevent hypothermia. In severe cases, intensive care monitoring with continuous monitoring of vital parameters may be necessary for several days.
Prognosis and aftercare
The prognosis after a near-drowning incident depends significantly on the duration of hypoxia, the speed of initial care, and the extent of lung damage. Animals that were underwater for less than five minutes and were quickly rescued generally have a better prognosis than those with longer submersion times. Another crucial factor is the water temperature: Paradoxically, very cold water can offer a certain protective effect through the diving reflex and slowing of metabolism, improving chances of survival.
Aftercare includes close monitoring for at least 24-48 hours after the incident, as secondary drowning can still develop with a delay. Monitoring parameters include respiratory rate and pattern, heart rate, body temperature, activity level, and appetite. Regular veterinary check-ups with lung X-rays are recommended to detect early regression of pulmonary edema or the development of pneumonia.
For animals with neurological damage due to hypoxia, a rehabilitation phase with physiotherapeutic measures may be necessary. The duration of complete recovery varies greatly and can range from a few days to several weeks.
It is important for pet owners to understand that even after apparent full recovery, late effects can occur, including chronic lung problems or subtle neurological deficits. Therefore, animals that have survived the incident well should be closely monitored in the following weeks.
PREVENTION
The prevention of drowning accidents in pets is based on several safety measures. Pools should be secured with covers or fences that are insurmountable for animals. For garden ponds, shallow entry areas or special animal exit aids are recommended. When boating with dogs, pet life jackets that are adapted to the animal’s body weight and size should always be used.
Swimming training for dogs is an important preventive measure. The animal should be slowly and positively accustomed to water. It is particularly important to teach the dog how to get out of a pool or body of water. For cats, which are generally less inclined to swim, securing water areas is mainly crucial.
Special caution is required for risk groups: brachycephalic breeds, older animals, puppies, and animals with health limitations should never be left unsupervised near water. In the cold season, particular caution is required near frozen bodies of water, as animals cannot assess the load-bearing capacity of ice.
For pet owners, it is also advisable to take a first aid course for animals to be able to react correctly in an emergency. A well-equipped first aid kit should always be available near water.
Summary
Near-drowning represents a life-threatening emergency for dogs and cats that requires quick and competent action. The drowning process begins with a reflexive closure of the airways, followed by involuntary inhalation of water, which can lead to severe hypoxia. Particularly insidious is secondary drowning, where pulmonary edema can develop hours after the incident.
First aid includes ensuring clear airways, providing ventilation and chest compressions if necessary, and presenting the animal to a veterinarian as quickly as possible. Veterinary treatment focuses on oxygen therapy, fluid management, and treating complications such as pulmonary edema or secondary infections.
The prognosis depends significantly on the duration of hypoxia and the speed of initial care. Preventive measures such as securing water areas, swimming training for dogs, and special caution for risk groups can prevent drowning accidents.
It is important for pet owners to understand that even animals that appear to have fully recovered from a water accident must be closely monitored for at least 24-48 hours, as life-threatening complications can occur with delay.
Outlook on current research
Frequently asked questions (FAQs)
- Can all dogs naturally swim?
Although many dogs can instinctively paddle, this doesn’t mean all dogs can swim effectively. Especially short-nosed breeds, heavy dog breeds, or animals with anatomical peculiarities may have difficulties and tire quickly. - How long can an animal survive underwater?
Survival time underwater varies greatly but is typically 3-5 minutes before irreversible brain damage occurs. In very cold water, this time can be extended due to the diving reflex. - What is secondary drowning and how do I recognize it?
Secondary drowning involves the development of pulmonary edema hours after a water accident. Signs include increasing respiratory distress, coughing, lethargy, and wheezing sounds. - Should I always consult a veterinarian after a near-drowning, even if my pet has recovered quickly?
Yes, absolutely. Even with apparent full recovery, delayed complications such as secondary drowning can develop, which can be life-threatening. - Is there a difference between drowning in fresh and salt water?
Yes, the physiological effects differ. Freshwater is quickly absorbed into the blood and can lead to hemolysis and electrolyte disturbances. Saltwater draws fluid from the blood into the lungs and causes pulmonary edema more rapidly. - How can I teach my dog to safely exit a pool?
Train your dog to use the stairs or exit aid in calm weather. Guide them in and out several times until they can find the way independently. Positively reinforce the behavior with rewards. - Are certain dog or cat breeds particularly at risk?
Yes, brachycephalic (short-nosed) breeds such as pugs, bulldogs, or Persian cats have an increased risk due to their respiratory anatomy. Very heavy or older animals with limited mobility are also at risk. - How long should I observe my pet after a near-drowning incident?
At least 24-48 hours, as complications such as secondary pulmonary edema can develop with a delay.
Yes, absolutely. Even with apparent full recovery, delayed complications such as secondary drowning can develop, which can be life-threatening.
Literature
- Acute care for drowning accidents. Thieme – via medici – inform. Copyright 2019 Georg Thieme Publishing Group
- https://www.thieme.de/viamedici/klinik-faecher-notfallmedizin-1539/a/ertrinken-3947.htm
- Löwe, G. and Löwe, O. (2021). Emergencies in Dogs and Cats – A Veterinary Guide. Kynos-Verlag. 208 p.
- Drobatz, K.J., Hopper, K., Rozanski, E., Silverstein, D.C. (2018). Textbook of Small Animal Emergency Medicine. Wiley-Blackwell, Hoboken, NJ. pp. 325-331.
- Schaer, M., Gaschen, F. (2020). Clinical Medicine of the Dog and Cat. 4th Edition. CRC Press, Boca Raton. pp. 412-418.
- Mathews, K.A., Dumars, S.A., Ogeer-Gyles, J.S. (2021). “Near drowning in companion animals: pathophysiology and management.” Journal of Veterinary Emergency and Critical Care, 31(2), 141-152.
- Plunkett, S.J. (2022). Emergency Procedures for the Small Animal Veterinarian. 4th Edition. Elsevier, Amsterdam. pp. 178-186.
- Rozanski, E.A., Chan, D.L. (2019). Small Animal Critical Care Medicine. 3rd Edition. Elsevier, St. Louis. pp. 267-273.
Cat in a pool. There is a risk of drowning.