Finding into death of Pamela Mary Bell

63y · Female·Aspiration of gastric contents and acute renal failure complicating intestinal pseudo-obstruction and urinary retention, in a woman with hyponatraemia

Pamela Bell, a 63-year-old woman with intellectual disability, epilepsy treated with carbamazepine, and chronic hyponatraemia, died from aspiration of gastric contents and acute renal failure complicating intestinal pseudo-obstruction. She presented with acute hyponatraemia and confusion on 30 October 2018. During her hospital stay, her hyponatraemia worsened despite fluid restriction and medication changes. On 5 November she refused care, vomited, had a possible seizure, and aspirated gastric contents. The coroner found no evidence that identified care issues were causally related to death. Clinical lessons include: recognising that carbamazepine-induced chronic hyponatraemia requires careful monitoring; considering pseudo-obstruction in patients with severe electrolyte disturbances; and recognising deterioration early to guide palliative versus interventional approaches.