Finding into death of Gretchen Heidi Anastasia Van Lunenburg

45y · Female·COVID pneumonia complicated by severe electrolyte abnormalities

A 45-year-old woman with cerebral palsy, Smith-Lemli-Opitz syndrome, and blindness died from COVID pneumonia complicated by severe electrolyte abnormalities. She was admitted three times over 3 weeks with progressive electrolyte disturbances (hyperkalaemia, hypernatraemia, metabolic alkalosis) following influenza, then COVID-19 infection. Difficult venous access due to contractures prevented adequate IV access and PICC line insertion, limiting ability to monitor and replace electrolytes. The team appropriately decided against invasive procedures under general anaesthesia given her frailty and complex disability. She transitioned to palliative care when oral intake remained poor despite treatment. The case illustrates challenges in managing electrolyte disturbances in patients with significant physical disabilities limiting vascular access, and appropriate end-of-life decision-making when invasive interventions are not feasible or safe.