This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Asphyxia, Subject name: Forensic Medicine
Which of the following is more likely to occur in salt water, rather than fresh water drowning? 
Select and explain. 
A. Volume overload, B. Faster death, C. Hemolytic anemia, D. Hypervolemia
B: Faster death
Answer: B: Faster death 
Explanation: Salt water drowning results in faster death than fresh water drowning. Salt water causes an osmotic shift of water into the alveolar spaces, with subsequent impaired oxygenation/ventilation and death (usually within 6 to 7 minutes). Patients have hypovolemia from these osmotic movements of fluid, and hemolysis is not a significant feature. As it enters the lungs, fresh water destroys surfactant activity, leading to alveolar collapse and intrapulmonary shunting (perfusion without ventilation). Water is reabsorbed into the vascular system, producing volume overload with subsequent hyponatremia and hemolysis of red blood cells. Ref: Krishnan vij Textbook of Forensic Medicine and Toxicology; 5th ed; Page no: 137