Acute renal failure is a recognized complication of near-drowning in fresh water and is generally attributed to the combination of hemolysis and hypotension. Hemolysis does not result from aspiration of sea water, and renal failure has not been regarded as a complication of near-drowning in salt water. In the present report two cases of acute and reversible oliguric renal failure followed episodes of submersion in sea water. Hemolysis was not present. We concluded that acute renal failure in both patients represented acute tubular necrosis resulting from a combination of hypoxia and hypotension.
Grausz H, Amend WJC, Earley LE. Acute Renal Failure Complicating Submersion in Sea Water. JAMA. 1971;217(2):207. doi:10.1001/jama.1971.03190020065016