Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Introduction. Pulmonary thromboembolism occurs usually by running 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 reports. We report two cases of sudden death of psychiatric patients wich were in both cases fixed during hospitalization. The first case: a woman, aged 26, treated a year with diagnose postpartum reactive psychosis. She was hospitalized because of worsening mental state with a dominant depressed mood, visual and auditory hallucinations. Her therapy was determined by diazepam, clozapine, haloperidol and lamotrigin. Suddenly, she 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: a man aged 45 years, a long-time alcoholic. On receiving, the diagnosis of Delirium tremens was established, and therapy administered diazepam and haloperidol. 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). In both cases patients were fixed. Conclusion. In the presented cases both psychiatric patients are younger the 50 years, not overweight, do not have changes of the venous blood vessels. At the present time, when the issue of medical responsibility often arises in these and similar cases of sudden death in patients treated in psychiatric clinics, can be expected to ask questions medical malpractice.