title: Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis - a case report.
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.
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Vikram
authors.initials: V
authors.lastname: Oke
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Schmidt
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Bikash
authors.initials: B
authors.lastname: Bhattarai
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Md
authors.initials: M
authors.lastname: Basunia
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Chidozie
authors.initials: C
authors.lastname: Agu
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Amrit
authors.initials: A
authors.lastname: Kaur
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Danilo
authors.initials: D
authors.lastname: Enriquez
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Quist
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Divya
authors.initials: D
authors.lastname: Salhan
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Gayam
authors.affiliation: Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA.
authors.forename: Prajakta
authors.initials: P
authors.lastname: Mungikar
keywords: antipsychotics; clozapine; constipation; schizophrenia; sepsis; syncope