Chlorpromazine accumulation and sudden death in a patient with renal insufficiency

Sudden death has been reported in psychiatric patients before and after the advent of antipsychotic medications. A case of sudden death following chlorpromazine administration in a schizophrenic patient is presented. After receiving a mean daily dose of 780 mg for five days, the patient died suddenly. Laboratory work on day 2 of hospitalization indicated a calculated creatinine clearance of 14 ml/min. The autopsy was noncontributory except for a blood chlorpromazine concentration of 1534 ng/ml. The potential cause of death in this patient and the proposed mechanisms of sudden death in psychiatric patients are discussed. The effect of renal and hepatic disease on chlorpromazine plasma concentrations is presented. This case is the first report of sudden death in a psychiatric patient with a documented elevated antipsychotic plasma concentration. It is also the first report of an elevated chlorpromazine blood concentration in a patient with renal insufficiency.