Finding into death of Robert William Keith

34y · Male·Unascertained; likely fatal cardiac arrhythmia secondary to electrolyte disturbance and QT interval prolongation

Robert William Keith, aged 34, was found deceased in his caravan on 28 June 2010. He had a long-standing history of paranoid schizophrenia managed with risperidone injections and oral medications under a Community Treatment Order. Post-mortem examination revealed elevated urea and creatinine consistent with dehydration and/or renal impairment. He had a documented prolonged QT interval on previous ECGs and multiple prior hospital admissions for vomiting-induced electrolyte disturbances (hypokalaemia, hypochloraemia, metabolic alkalosis). The coroner concluded his death was likely due to an acute electrolyte disturbance causing QT prolongation and fatal cardiac arrhythmia. Clinicians should recognise that antipsychotic medications and recurrent electrolyte abnormalities increase arrhythmia risk, necessitating regular ECG monitoring, electrolyte surveillance, and aggressive management of vomiting episodes in vulnerable patients.