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Case Report
 
Near-syncope after swimming in cold water
Thomas J. Nuckton1, Ritik Chandra2, Kelley D. Heye3, Susan K. Lauritzen4, Mary Magocsy5
1Department of Medicine, California Pacific Medical Center, San Francisco, CA.
2Department of Emergency Medicine, California Pacific Medical Center, San Francisco, CA.
3Motion Starved Physical Fitness, San Francisco, CA.
4Urgent Care (retired), San Francisco General Hospital, San Francisco, CA.
5EMS Agency, Department of Emergency Management, San Francisco, CA.

Article ID: 100024CRINTTN2016
doi:10.5348/crint-2016-24-CR-5

Address correspondence to:
Thomas J. Nuckton
MD, MS, Department of Medicine, California Pacific Medical Center, San Francisco, CA United States
6 Locksley Avenue, #8J North
San Francisco, CA 94122-3822

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How to cite this article:
Nuckton TJ, Chandra R, Heye KD, Lauritzen SK, Magocsy M. Near-syncope after swimming in cold water. Case Rep Int 2016;5:18–21.


Abstract
Introduction: Swimming in cold water ("polar bear" swimming) is growing in popularity and attracting individuals of many ages and athletic backgrounds.
Case Report: A case of 60-year-old woman swimmer who experienced near-syncope after swimming for 20 minutes in cold water (water temperature: 14°C) without a wetsuit. The patient did not have signs of clinically-relevant hypothermia but was brought to a sauna after swimming. Pre-existing volume depletion, with subsequent orthostatic hypotension made worse by swimming in cold water, was the most likely etiology of near-syncope in this patient. Clinical improvement was noted when the patient started shivering after being removed from the sauna, and all symptoms resolved after the administration of 1 L of normal saline.
Conclusion: As cold-water swimming continues to gain in popularity, emergency medicine practitioners may see more cases of swimming-related syncope and near-syncope. Depending on the presentation, the priority of treatment may be the correction of volume depletion and orthostatic hypotension, rather than active rewarming.

Keywords: Cold water, Exercise, Hypothermia, Near-syncope, Swimming, Syncope


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Author Contributions
Thomas J. Nuckton – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Ritik Chandra – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Kelley D. Heye – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Susan K. Lauritzen – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Mary Magocsy – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Thomas J. Nuckton et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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