The mystery of what led to the deaths of two vacationing American sisters in their tropical island villa likely won't be solved until investigators see the results of toxicology tests. The question that keeps arising for U.S. medical experts reading the news from afar is: Why did both sisters die?
Annie Marie Korkki, 37, and Robin Marie Korkki, 42, were found motionless in the bed of their villa last week by hotel staff at a resort on Seychelles' main island. Autopsies conducted Wednesday determined the Minnesota natives died from acute pulmonary edema, or fluid in their lungs, according to a police report obtained by Minnesota television station KARE.
Cerebral edema, or fluid in the brain, was also cited in Annie Korkki's death. The report said no visible signs of injuries were found. Police said the women were seen drinking and were helped to their room by hotel personnel the night before they were found dead. The investigation is ongoing and toxicology tests are pending.
Here are some questions and answers about the many possibilities:
WHAT CAUSES FLUID IN THE LUNGS AND BRAIN?
A virus? An overdose? Alcohol poisoning? Yes, yes and yes. There's a long list, said Dr. Patrick Lank, a Northwestern Medicine assistant professor of emergency medicine in Chicago.
"One of the more common things we see in the emergency department is related to drug overdose," Lank said. "Alcohol would be a really common one. Also, cocaine, heroin and other opioids, or MDMA, which also is known as ecstasy or molly."
Viral infection could cause both pulmonary and cerebral edema, Lank said. "Trauma would be another potential cause" but would likely cause external marks.
"Two people at the same time is odd," Lank said. "It suggests more of a toxicologic or environmental cause, or a potential infection if they're traveling together."
WHAT COULD TOXICOLOGY TESTS FIND?
Basic screens on blood and urine can detect opiates, amphetamines, marijuana, alcohol and barbiturates. Confirming those results can take days and sometimes requires repeated testing.
Poisons such as carbon monoxide could turn up. A Delaware family nearly died in 2015 during a Caribbean vacation from exposure to a banned pesticide.
"When two dead people are in a hotel room there are a few possibilities that come to mind," said Bruce Goldberger, chief of the Division of Forensic Medicine at the University of Florida College of Medicine. "It's possible they were exposed to some sort of toxin."
Carbon monoxide from a hot water heater is a possibility, Goldberger said. "Then the other would be alcohol and/or drugs," he said.
Baltimore-based medical examiner David Fowler of the College of American Pathologists said a good forensic lab will be able to answer many questions.
Brain swelling and fluid-filled lungs "are the hallmarks of a drug intoxication until proven otherwise," Fowler said.
"All this is speculation," Fowler added. "The chance of two people dying of natural causes at the same time in a hotel room is very rare. And you don't need a medical professional to tell you that."
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