Epistaxis after prolonged water immersion in a hot Jacuzzi.

Sir, Water immersion up to the neck can cause many haemodynamic changes including increased central venous pressure and central blood volume as well as diuresis, natriuresis and decreased vasopressin levels.'-3 These effects have also been noticed after use of the Jacuzzi,4,5 especially one with water temperature over 39°C6. Vasopressin stimulates production of thromboxane,7 and vasopressin infusion is used in treatment of bleeding diathesis such as Mallory-Weiss syndrome. A 39 year old businessman, in excellent health, stayed in a very hot Jacuzzi (approx. 41C) for over 90 minutes, keeping only his head above water. About an hour after leaving the health club, he presented with a very copious epistaxis. He was treated at an outpatient clinic, and the epistaxis resolved. He claimed that he never had nosebleeds prior to this instance and that his usual stay in the Jacuzzi was for only 15 minutes. Thus, it is possible that prolonged head-out water immersion in the hot Jacuzzi could affect platelet aggregation and induce bleeding in the susceptible. Joshua Backon Mount Pleasant Hospital, Addiction Studies Foundation, POB 16336, Jerusalem, Israel.