Coroner's Finding: DONNELL Kevin George

60y · Male·end stage refractory chronic congestive cardiac failure on a background of chronic renal failure and schizophrenia

A 60-year-old man with chronic schizophrenia, end-stage cardiac failure, renal failure, and dementia died of refractory congestive heart failure while under Mental Health Act detention. He had multiple comorbidities including psychogenic polydipsia, recurrent hypernatraemia, and severely impaired left ventricular function (EF 18%). Despite aggressive diuresis attempts, his fluid balance remained difficult to manage due to both his cardiac disease and psychiatric condition causing poor compliance with fluid restriction. Palliation was appropriately chosen as his symptoms proved refractory. The coroner found the detention order lawful, the medical treatment lawful, appropriate, humane and necessary, and made no recommendations. This case highlights the clinical complexity of managing patients with concurrent severe psychiatric illness and end-stage cardiac disease, particularly when psychiatric symptoms impair compliance with necessary medical restrictions.