Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 2)
Pulmonary thromboembolism and sudden death in psychiatric patients – Two cases report
Authors:
Nadica Marinković, Dragana Rančić
Introduction. Pulmonary thromboembolism occurs usually byrunning a thrombus from the deep veins of the legs rarely periprostatic
or periuteric veins. Virchow's triad of necessary conditions
for the occurrence of thrombosis involves disruption of
blood flow, disruption of blood chemistry and damage to the
vessel wall. Venous thrombosis is often associated with the implementation
of antipsychotic therapy. Case report. We reported
two cases of sudden death of psychiatric patients who
were in both cases fixed during hospitalization. The first case
was a 26-year-old woman treated a year with the diagnose of
postpartum reactive psychosis. She was hospitalized because of
mental state worsening with a dominant depressed mood, visual
and auditory hallucinations. Her therapy was determined by
diazepam, clozapine, haloperidol and lamotrigine. Suddenly, the
patient died on the fifth day of hospitalization. The autopsy
showed massive thromboembolism of the pulmonary artery
branches. Toxicological analysis revealed the presence of therapeutic
doses of antipsychotics. The second case was a-45-yearold
men, a long-time alcoholic. On admission, the diagnosis of
delirium tremens was established, and diazepam and haloperidol
were administered. On the fifth day of hospitalization, he suddenly
died. The autopsy showed thromboembolism of the
branch of the pulmonary artery. Toxicological analysis established
the presence of nordiazepam in urine (0.06 mg/L). Both
patients were fixed during hospitalization. Conclusion. Both
presented psychiatric patients were younger than 50 years, were
not overweight, did not have changes of the venous blood vessels.
Nowadays, when the issue of medical responsibility often
arises in these and similar cases of sudden death in patients
treated in psychiatric clinics, the questions on medical malpractice
could be expected.
