Coronial

154 results for malnutrition

VIChospital2024-12-17

Finding into death of Yvonne Eddolls

68y · Female·Sepsis (palliated)

…SA osteomyelitis. She was hospitalised in December with sepsis, acute kidney injury, hypernatraemia and malnutrition. The coroner found death due to natural causes. Clinical lessons include: early recognition and aggress…

general practiceemergency medicinedelaysystem
VIC2025-05-14

Finding into death of Adrian Colin Phillips

58y · Male·Complications of community-acquired pneumonia, in a man with chronic lung diseas…

Adrian Phillips, a 58-year-old man with intellectual disability and chronic lung disease (emphysema, bronchopulmonary aspergillosis, asthma), died from community-acquired pneumonia caused by MRSA and Rhinovirus. He prese…

general practicerespiratory medicinebromhexine
QLDhospital2009-10-08

Kerkvliet, Kristen

1y · Female·acute myocardial infarction secondary to Kawasaki's Disease

…possible treatment of Kawasaki's Disease. Key clinical lesson: unexplained failure to thrive and severe malnutrition warrant urgent investigation for serious underlying pathology, particularly vasculitic diseases affecti…

paediatricsgeneral practicediagnostic
WAcommunity2020-06-03

Inquest into the Suspected Death of Anthony JOHNSTONE

33y · Male·Exposure to the elements whilst in a mentally unstable state; manner of death Op…

Anthony Johnstone, a 33-year-old Aboriginal man, disappeared in late October 1996 from Wyndham, Western Australia, while in an acutely unstable mental state associated with chronic alcohol use disorder, withdrawal sympto…

alcohol
QLDaged care2017-09-20

Mr RO'H - Non-inquest findings

69y · Male·septic shock due to infected decubitus ulcers complicated by osteomyelitis

…assessment and prevention planning, inadequate wound documentation and management, failure to recognise malnutrition's role in pressure ulcer formation (5.7 kg weight loss in one week), failure to escalate deteriorating …

geriatric medicinegeneral practicediagnosticsystemdicloxacillin
ACTcommunity2026-05-26

Inquest into the death of Donald Morley

93y · Male·Complications of invasive squamous cell carcinoma of the scalp

…ell carcinoma of the scalp, with contributing factors including coronary and valvular heart disease and malnutrition. The cancer had developed before custody and was managed in the community before his arrest. While in c…

palliative carepsychiatry
VIChospital2015-02-12

Finding into death of Mary Mulqueen

57y · Female·small bowel ischaemia; distal gastrectomy

…shortened functional segment and antiperistaltic limb. This reconstruction likely contributed to severe malnutrition and malabsorption over the following year despite multiple attempts at nutritional support. However, th…

general surgerygastroenterologyproceduraldiagnosticesomeprazole
WAhospital2026-04-01

Inquest into the Death of David John HATCHER

60y · Male·Pulmonary tuberculosis in a man with chronic obstructive pulmonary disease, with…

…Key factors in his death included TB on a background of extensive pre-existing lung damage, significant malnutrition (he declined nutritional support initially), and low mood affecting engagement with treatment. The coro…

respiratory medicineinfectious diseasesproceduralsystem
NSWhospital2019-12-13

Inquest into the death of Lorraine BARNES

85y · Female·sepsis, with aspiration pneumonitis being an antecedent cause. Iatrogenic injury…

…ce, died from sepsis with aspiration pneumonitis following iatrogenic lung injury. She developed severe malnutrition and electrolyte disturbances after refusing oral intake from hospital day 5 onwards. A fine-bore nasoga…

general medicinerespiratory medicinediagnosticsystemciprofloxacin
QLDhospital2013-05-22

Thoresen, Cynthia

88y · Female·pulmonary thromboembolism due to fractured right femur due to a fall

… pain and immobility. The patient remained bedbound in filthy conditions, developing pressure sores and malnutrition. Hospital staff provided appropriate, multidisciplinary care including prophylactic anticoagulation, bu…

orthopaedic surgeryemergency medicinedelaysystemmorphine
VIChospital2015-09-07

Finding into death of Jay Dion Sykes

18y · Male·Aspiration pneumonia in a setting of acquired brain injury from non-accidental h…

…ar family communication in complex disability cases and the challenges of managing severe dysphagia and malnutrition in young adults with profound neurological disability.

general medicineemergency medicinecommunicationesomeprazole
WAhome2011-04-21

Inquest into the Death of Whitehouse

3y · Male·unascertainable; malnourishment was a significant contributing factor

…he had crossed centile charts and was below the 3rd percentile at death. The coroner found the cause of malnutrition was likely inadequate nutrition provision rather than medical disease, though his exact death mechanism…

paediatricsgeneral practicecommunicationdelaymethamphetamine
TAShome2021-04-12

Coroner's Finding: Rubenach, Timothy Luke

32y · Male·Aspiration pneumonia and reflux oesophagitis

Timothy Luke Rubenach, aged 32, died of aspiration pneumonia following severe reflux oesophagitis. He had profound intellectual disability and drug-resistant epilepsy from meningococcal infection at 5 months. His parents…

general practicegastroenterologymorphine
QLDhospital2013-04-19

Brockel, Ronald James

64y · Male·aspiration pneumonia following insertion of a jejunostomy tube

…mpromised nutrient absorption (primarily occurring in the jejunum) and likely contributed to his severe malnutrition and weight loss over six months. Though confirmation bias led clinicians to accept the surgeon's assura…

general surgerygastroenterologyproceduraldiagnosticomeprazole
TAShospital2023-02-20

Coroner's Finding: de-identified RI

68y · Male·community-acquired pneumonia in a setting of advanced centriacinar emphysema, al…

…omplicated by asplenia (absent splenic function), chronic liver disease from alcohol misuse, and severe malnutrition. He presented with syncopal episodes, cachexia, and metabolic derangement. Critical clinical lessons in…

general medicinegeneral practicediagnosticcommunicationparacetamol
QLDhome2025-06-25

Non-inquest findings into the death of an eight month old twin whose family was known to Child Safety

0y · Male·Severe acute dehydration and acute malnutrition

An eight-month-old boy died from severe acute dehydration and malnutrition after receiving no or minimal fluid or food intake during a three-day drug binge by his mother and her …

paediatricsemergency medicinediagnosticsystemmethamphetamine
NSWhospital2015-08-17

Inquest into the death of Manjit SINGH

33y · Male·hypoxic respiratory failure following right pneumonectomy for treatment of sever…

…ion risk. His disease relapsed despite initial drug treatment, necessitating surgery. The coroner found malnutrition a contributory factor. Systemic improvements needed in coordination between immigration and health auth…

respiratory medicinecardiothoracic surgerydiagnosticcommunicationtuberculosis medications
SAaged care2024-06-19

Coroner's Finding: Perkins, Ann

77y · Female·general inanition on a background of dementia, chronic subdural haematoma and ri…

Mrs Ann Perkins, aged 77, died from general inanition with dementia, chronic subdural haematoma, and fractured neck of femur as contributing factors. She sustained an unwitnessed fall at her aged care facility in Decembe…

geriatric medicineorthopaedic surgery
VIChospital2018-11-26

Finding into death of Sarah Hammoud

22y · Female·septic shock complicating osteomyelitis secondary to cellulitis in a woman with …

Sarah Hammoud, aged 22 with cerebral palsy and intellectual disability, died from septic shock complicating osteomyelitis secondary to cellulitis. She resided in a supported residential service and had recurrent elbow in…

general practiceorthopaedic surgerycommunicationsystemantibiotics
NSWhospital2018-05-30

Inquest into the death of Marcia Clark

83y · Female·Combined effects of severe malnutrition and infection (septicaemia secondary to …

Mrs Clark, 83, died from severe malnutrition and infection including septicaemia from an infected sacral pressure ulcer that had existed for 7 month…

geriatric medicinegeneral practicediagnosticcommunicationolanzapine

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