Imagine that your mother is hospitalized for pneumonia. Her physician tells you that the antibiotic treatment has been successful and that she is expected to be discharged within two days.
When you return to the hospital, however, you learn that her condition has deteriorated significantly. That evening, she is transferred to the intensive care unit. Early the following morning, you are informed that she has died and that the treating physician cannot explain why.
The death certificate later records the manner of death as “natural.”
Throughout her hospitalization, she had been receiving as many as 15 medications per day. Her family therefore asked SCHOLZ DataBank to examine whether adverse drug effects or drug-drug interactions may have contributed to the unexpected fatal outcome.
A medication-related scenario may emerge
An analysis using the SCHOLZ DataBank Adverse Drug Risk Control Panel and the MDDI Calculator identified indeed a plausible chain of events including:
- Acute kidney injury
- Potentially toxic multiple drug-drug interactions (MDDI)
- Severe internal bleeding causing hemopericardium
- Cardiac arrest as the final event
The findings indicated that the patient’s medications caused serious multiple drug-drug interactions (MDDI) with toxic plasma plasma levels of a drug which were additionally elevated by acute kidney injury (AKI); the coincidence of these adverse effects played probably the decisive role in the fatal outcome.
As clinical decision support applications, the SCHOLZ DataBank tools help uncover clinically significant medication risks and provide medical, pharmacological, and legal experts with a foundation for further investigation.
Why polypharmacy requires closer examination
Patients with multiple diseases frequently receive medications from several physicians and specialists. When many drugs are taken simultaneously, reviewing each medication separately may not be enough.
A comprehensive analysis should consider:
- Drug-drug interactions including multiple drug-drug interactions (MDDI)
- Overlapping, cumulative adverse effects
- Contraindications due to diseases and risk factors
- Dosage and duration of treatment
- Kidney and liver function
- Age, sex, and pharmacogenomics
- The cumulative risk of the complete medication regimen
A death classified as natural does not necessarily exclude medications as contributing or decisive factors of the fatal outcome. This may be particularly relevant when a patient dies unexpectedly while receiving extensive polypharmacy and no clear clinical explanation is available.
The wider impact is substantial. A 2018 study estimated that the costs of morbidity and mortality in the United States associated with nonoptimized medication therapy amounted to approximately $528.4 billions annually in 2016.
Supporting medication-related investigations
SCHOLZ DataBank can support complex medication reviews undertaken by:
- Families seeking greater clarity about an unexpected death
- Medical malpractice and wrongful death attorneys
- Pharmacology and clinical pharmacology expert witnesses
- Physicians, forensic experts, and pathologists
- Hospitals, insurers, and patient safety organizations
- Pharmaceutical and pharmacovigilance professionals
When a serious or fatal outcome cannot be adequately explained and the patient was receiving multiple medications, a structured medication risk analysis may provide important additional insight.
If you are investigating an unexpected adverse event, suspected medication-related injury, or death involving polypharmacy, please contact SCHOLZ DataBank to discuss how our clinical decision support applications may assist your review.