Family claim an increased dose of lithium led to the sudden death of woman, 42
THE family of a woman who died suddenly claim her death was linked to her being prescribed an increase of the daily dose of lithium used to treat her mental health issues above agreed levels a week earlier.
An inquest into the death of Sheena Eivers, 42, at her home in Saggart, Co. Dublin, on July 1, 2021 heard that her relatives believe serotonin syndrome – a potentially fatal condition caused by medication that builds up high levels of serotonin in the body – had played a role in her unexpected death.
However, the chief State pathologist, Linda Mulligan, told a sitting of Dublin District Coroner’s Court that serotonin syndrome was ‘highly, highly unlikely’ to be responsible for her death.
The inquest had previously been adjourned by coroner Clare Keane to seek a review by Professor Mulligan of several postmortems carried out on Ms Eivers as well as her medical records in order to address concerns raised by her family. Prof. Mulligan concluded the most likely cause of Ms Eivers’s death was an irregular heartbeat linked to her chronic kidney disease with diarrhoea that she had suffered for a couple of days as a contributory factor.
She acknowledged it was possible that the diarrhoea could be linked to a Covid-19 vaccine she had received the previous day.
The pathologist said she would not have expected Ms Eivers to have developed serotonin syndrome as medical records showed she had been taking the same drugs including lithium for 20 years. Addressing a resumed hearing of the inquest, the solicitor for Ms Eivers’s family, Niall Tansey, said the deceased, who had been treated by Clondalkin Mental Health Services (CMHS) since 2009 for premenstrual dysphoric disorder, had a moderate kidney disease which was not terminal.
Mr Tansey said she was considered ‘a healthy person’ who did not drink or smoke.
‘Nobody expected Sheena would die,’ he added. The inquest heard Ms Eivers was first diagnosed with chronic kidney disease in January 2020 as a result of which her daily dose of lithium was reduced from 800mg to 400mg.
Mr Tansey said her mother, Margaret Eivers, was not allowed to attend a consultation that her daughter had on May 27, 2021 with CMHS when the deceased had asked for her daily dose to be increased to 600mg. He claimed Ms Eivers’s family were very concerned at this development.
On June 3, 2021, a family consultation with CMHS staff agreed a care plan for Ms Eivers which included that her daily dose of lithium would not exceed 600mg.
One week later, another consultant from CMHS agreed she would not be given more than 600mg of lithium daily, but would also prescribed diazepam, the inquest heard.
Two weeks later, Mr Tansey said the same consultant had ‘inexplicably’ decided to increase her daily dose of lithium back up to 800mg, even though it had been considered ‘too dangerous’ a fortnight earlier. Mr Tansey said the consultant had also crucially failed to adjust the dosage for any of her other medications.
In particular, Mr Tansey said the amount of risperidone – another anti-psychotic medication – should have been reduced as it had originally been given to Ms Eivers as a replacement for lithium. The solicitor said the confusion felt by Ms Eivers’s family about her death had been compounded by subsequent events including the fact that three postmortem reports had been provided with each making a different finding about the cause of her death. He pointed out that they were told that lithium was not checked in one autopsy, while another had found toxic levels of the drug in her body, which the family had found ‘deeply upsetting and concerning’. The inquest heard that a report prepared at the State Laboratory at Backweston, Co. Kildare, on the results of an outsourced test conducted by a French laboratory, had incorrectly overestimated the amount of lithium in Ms Eivers’s body ‘one thousand-fold’.
A representative of the State Laboratory, Julie Tierney, confirmed the mistake had been due to ‘human error’ but said the process had been changed to prevent the same problem recurring. Mr Tansey stressed that a pathologist who had conducted the original postmortem had stated that it was not expected that Ms Eivers would die from her kidney condition.
Calling for a verdict of medical misadventure, the solicitor remarked: ‘The medication must have played a role in her death.’
However, Rebecca Graydon BL, counsel for CMHS, claimed that Prof. Mulligan had excluded serotonin syndrome as the likely cause of Mr Eivers’s death. Ms Graydon said there was no evidence that medication had played any role in her death.
Concluding the inquest, Dr Keane said she had been persuaded by the medical evidence she had heard in the case. Returning a narrative verdict, the coroner said there had been ‘complicated’ issues but that there was no evidence of acute lithium toxicity in the deceased’s body, which had been clarified after an error in an earlier postmortem.
Expressing her condolences to Ms Eivers’s relatives, she said it was apparent they were a close family who had suffered a shocking loss that they must feel every day. Following the hearing, Mr Tansey said Ms Eivers’s family were disappointed at the verdict given the ‘catalogue of errors revealed over two days’.
However, the solicitor expressed satisfaction that a number of issues had been clarified, although he said her family still believe that serotonin syndrome contributed to her death. Mr Tansey said they also welcomed the changes made by the State Laboratory.
‘Nobody expected Sheena to die’ ‘Deeply upsetting and concerning’