Finding into death of Julie-Anne Marie Kettle

56y · Female·Bronchopneumonia in the setting of supratherapeutic lithium levels

Julie-Anne Kettle, a 56-year-old woman with intellectual disabilities residing in a group home, died from bronchopneumonia in the setting of supratherapeutic lithium levels. She was on lithium 1250 mg/day for psychiatric management and fluid restriction (1.5 litres/day) for fluid retention. Despite GP reviews showing clinical signs concerning for lithium toxicity (lethargy, tremors, nausea, poor appetite), her lithium level was not rechecked between December 2017 and early March 2018. When renal impairment and high lithium levels were finally identified on 2 March 2018, she was appropriately admitted to hospital but deteriorated and died two days later from aspiration pneumonia. The coroner found no fault with medical management by the GP or hospital, which was timely and appropriate. However, systemic failures in disability services management (delayed provision of compression stockings, inadequate falls risk management, unauthorized use of restrictive interventions, and poor inter-resident compatibility management) were identified, though these did not directly contribute to death. The case highlights risks of lithium toxicity in patients with fluid restrictions and cognitive impairment requiring enhanced monitoring.