Gittler test in drowning.
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Gettler chloride test drowning freshwater saltwater forensic pathology
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I now have comprehensive information from multiple authoritative forensic medicine textbooks. Here is the complete answer:
Gettler Test in Drowning
Note on spelling: Often written as "Gittler" in Indian exam contexts, but the correct name is Gettler's Test, named after Alexander O. Gettler, who published the method in 1921 in JAMA.
What It Is
The Gettler test is a blood chloride analysis performed at autopsy to confirm drowning and differentiate freshwater from saltwater (sea water) drowning. It compares the chloride concentration in blood taken separately from the right and left sides of the heart.
Physiological Basis
Normally, chloride content is equal on both sides of the heart, approximately 600 mg per 100 mL.
In freshwater drowning:
- Water absorbed from the lungs into the pulmonary circulation dilutes the blood.
- Blood volume in the left heart increases by up to 72% within 3 minutes.
- This hemodilution causes the chloride level in left side of heart to fall - up to 50% lower than normal.
- Result: Left side chloride < Right side chloride
In saltwater (sea water) drowning:
- Sea water (hypertonic) draws fluid from the pulmonary circulation into the alveolar spaces.
- This hemoconcentration raises chloride levels.
- Blood in the left side of the heart shows increased chloride - up to 30-40% higher.
- Result: Left side chloride > Right side chloride
Interpretation
| Finding | Interpretation |
|---|---|
| Left side Cl < Right side Cl | Freshwater drowning (hemodilution) |
| Left side Cl > Right side Cl | Saltwater drowning (hemoconcentration) |
| Difference ≥ 25 mg/100 mL | Significant - indicates drowning |
Value and Limitations
The test is considered of doubtful (unreliable) value and is now largely historical. Reasons for unreliability:
- Postmortem redistribution of electrolytes across cardiac chambers distorts results.
- Prolonged immersion, decomposition, or resuscitation attempts all alter chloride levels.
- Ante-mortem cardiac disease can cause unequal chloride distribution independently.
- Both false positives and false negatives occur frequently.
- DiMaio's Forensic Pathology states directly: "All of the aforementioned tests are unreliable and of no help in diagnosing drowning."
Historical Context of Laboratory Tests for Drowning
| Year | Investigator | Contribution |
|---|---|---|
| 1902 | Carrara | Specific gravity and freezing point differences in heart blood |
| 1903 | Placzela | Emphasized specific gravity method |
| 1921 | Gettler | Chloride test - 25 mg/100 mL difference between sides |
| 1944 | Moritz | Proposed magnesium as more reliable (especially for sea water drowning) |
| 1941 | Incze | Diatom test in lungs and systemic circulation |
Related Tests (for comparison)
- Plasma specific gravity: In drowning, specific gravity of left side plasma < right side plasma (opposite in non-drowning). Also unreliable.
- Magnesium test: Magnesium in left heart blood > 1.25 mg/1000 mL more than right side in saltwater drowning. Suggested as more reliable than chloride.
- Strontium test: Raised serum strontium in drowning; difference between left and right always >75 µg/L in sea water drowning.
- Diatom test: Most widely used today, though also controversial.
Sources:
- The Essentials of Forensic Medicine and Toxicology, 36th ed. (2026), pp. referenced (Gettler Test section)
- P.C. Dikshit Textbook of Forensic Medicine and Toxicology, Laboratory Diagnosis of Drowning
- DiMaio's Forensic Pathology, 3rd ed., Tests for Drowning
- PMC review on drowning investigation (Gettler 1921 original cited as reference 90)
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