swimming in cold water ("polar bear" swimming) is growing in popularity and attracting individuals of many ages and athletic backgrounds. case report: A case of 60-year-old woman swimmer who experienced near-syncope after swimming for 20 minutes in cold water (water temperature: 14°c) without a wetsuit. the patient did not have signs of clinicallyrelevant hypothermia but was brought to a sauna after swimming. Pre-existing volume depletion, with subsequent orthostatic hypotension made worse by

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... imming in cold water, was the most likely etiology of near-syncope in this patient. clinical improvement was noted when the patient started shivering after being removed from the sauna, and all symptoms resolved after the administration of 1 L of normal saline. conclusion: As cold-water swimming continues to gain in popularity, emergency medicine practitioners may see more cases of swimmingrelated syncope and near-syncope. Depending on the presentation, the priority of treatment may be the correction of volume depletion and orthostatic hypotension, rather than active rewarming.