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Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis – a case report

Authors Oke V, Schmidt F, Bhattarai B, Basunia M, Agu C, Kaur A, Enriquez D, Quist J, Salhan D, Gayam V, Mungikar P

Received 16 April 2015

Accepted for publication 27 May 2015

Published 11 September 2015 Volume 2015:8 Pages 189—192

DOI https://doi.org/10.2147/IMCRJ.S86716

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Professor Ronald Prineas

Vikram Oke, Frances Schmidt, Bikash Bhattarai, Md Basunia, Chidozie Agu, Amrit Kaur, Danilo Enriquez, Joseph Quist, Divya Salhan, Vijay Gayam, Prajakta Mungikar

Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA

Abstract: Clozapine is the preferred antipsychotic used for the treatment of resistant schizophrenia with suicidal ideation. The drug is started at a low dose and gradually increased to a target dose of 300–450 mg/day. It is well known to cause agranulocytosis and neutropenia. Several cases of fatal sepsis have been reported in neutropenic patients and emphasis is placed on monitoring for agranulocytosis; however, clozapine also causes intestinal hypomotility and constipation, which if unrecognized can lead to intestinal obstruction, bowel necrosis, and intra-abdominal sepsis. Reduced behavioral pain reactivity in schizophrenics may alter the ability to express pain, potentially leading to a delay in the presentation for medical attention. We report a case of fatal intra-abdominal sepsis secondary to an unrecognized case of clozapine-related constipation.

Keywords: antipsychotics, clozapine, schizophrenia, syncope, constipation, sepsis

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