Case reportFatal water intoxication during olanzapine treatment: A case report
Introduction
Olanzapine is one of the most common antipsychotic drugs used for first-line treatment of schizophrenia in Japan. It is widely used worldwide as it can also be used to treat bipolar depression. Olanzapine has various affinities for multiple receptors, including those for dopamine D2, serotonin 5-hydroxytryptamine (HT)2A, 5-HT2C, 5-HT6, adrenaline alpha-1, histamine H1, and muscarine M1–M5 [1]. Therefore, olanzapine is associated with various clinical and toxic manifestations [2], [3], [4], [5], [6]. In particular, dry mouth caused by metabolic disorder, a known adverse effect of olanzapine, occurs significantly more frequently in patients treated with olanzapine than in those treated with other drugs. In this study, we report a case of death from water intoxication while receiving olanzapine treatment. Although various factors are known to cause water intoxication, an adverse effect of olanzapine in the present case might have aggravated water intoxication.
Section snippets
Case report
A man in his twenties who was diagnosed with schizophrenia at in his late teens had over the few months preceding his death drunk such large amounts of water that his abdomen was expanded and he had been vomiting and collapsing. The night before his death, his family reported he drank a large amount of water, vomited, collapsed, and snored loudly while sleeping, but they did not view the event seriously as he did it routinely. The following morning, he was found dead. He had no history of
Cadaveric study
To compare against the findings of the present case, postmortem changes in electrolyte concentrations were examined in the serum and vitreous humor obtained from 18 cadavers (15 males, 3 females; aged 25 ̃ 86 years, mean age of 60.88 years at time of death) at 1–10 days postmortem (Table 1). Cadavers with causes of death that may have affected body fluid composition were excluded.
Results
As shown in Table 2, the mean (±standard deviation) sodium concentration for the 18 cadavers was 108.4 ± 9.58 mEq/L in the serum, 129.44 ± 8.84 mEq/L in the right vitreous humor, and 132.76 ± 10.28 mEq/L in left vitreous humor, concentrations that were higher than in the present case.
Discussion
Although there is currently no established diagnostic standard for water intoxication, a diagnosis is based on the observation of behavior such as polyposia, blood test results such as hyponatremia, and previous clinical history such as epileptic stroke and disturbance of consciousness [7]. In the present case, a large amount of water was consumed before death, autopsy revealed edema in the brain and lung, and the vitreous sodium concentration, which has been shown to be relatively resistant to
Conclusion
The cause of death in this case was judged to be hyponatremia by water intoxication based on the results of the autopsy, biochemical examination, and drug test. Moreover, it is likely that an adverse effect of olanzapine in the present case might have aggravated water intoxication.
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