clozapine and Shock--Septic

Clozapine is known to cause fecal impaction and ileus with resultant colonic necrosis due to compression of colonic mucosa. There are rare reports of clozapine causing necrosis of other portions of the gastrointestinal tract unrelated to constipation. We describe a case of acute necrosis of the upper gastrointestinal tract and small bowel to due to clozapine and quetiapine.. A 66-year-old white man with a past medical history of schizophrenia, maintained on clozapine and quetiapine, presented with hypoxic respiratory failure caused by aspiration of feculent emesis due to impacted stool throughout his colon. His constipation resolved with discontinuation of clozapine and quetiapine, and his clinical condition improved. These medicines were restarted after 2 weeks, resulting in acute gastrointestinal necrosis from the mid esophagus through his entire small bowel. He died due to septic shock with Gram-negative rod bacteremia.. Clozapine may cause acute gastrointestinal necrosis.

Topics: Aged; Antipsychotic Agents; Clozapine; Constipation; Endoscopy, Digestive System; Esophagus; Fatal Outcome; Fecal Impaction; Gastrointestinal Diseases; Gram-Negative Bacterial Infections; Humans; Intestine, Small; Male; Necrosis; Respiratory Aspiration; Respiratory Insufficiency; Schizophrenia; Shock, Septic; Stomach; Vomiting

Topics: Abdomen; Abdominal Pain; Acute Disease; Adult; Blood Coagulation Disorders; Clozapine; Colon; Diagnosis, Differential; Dilatation, Pathologic; Gastrointestinal Motility; Humans; Male; Megacolon, Toxic; Radiography; Schizophrenia, Paranoid; Serotonin Antagonists; Shock, Septic