A striking picture in forensic pathology is the presence of pinkish foam coming from the mouth and nostrils of a drowning victim. Other conditions may also cause foam to develop in the upper respiratory tract.
Requirements for foam formation:
(1) acute pulmonary edema with protein-rich fluid in the alveoli
(2) water and fluid in the airways
(3) abnormal ventilation, mixing air, fluid and edema fluid
Differential diagnosis of foam at the mouth:
(1) drowning
(2) fire
(3) electrocution
(4) epilepsy
(5) head injury
(6) hydrogen peroxide ingestion
(7) drug overdose (cocaine, opiates, barbiturates)
(8) toxin exposure (organophosphate)
(9) acute heart failure
Pressing on the chest of a drowning victim will cause more foam to appear.
The presence of foam supports the hypothesis that the person was still alive at the time of the exposure since ventilation is a requirement for its formation. The absence of foam does not exclude this possibility.
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