BERNARD JOHN FAGG · Prevention of Future Deaths report

On 21st December 2017 an inquest concerning the death of BERNARD JOHN FAGG was opened. I resumed and concluded the inquest on 17th May 2018.
The conclusion of the inquest was that Bernard John Fagg died following a necessary medical procedure.

Bernard John Fagg was admitted to hospital on 5/12/17. He had been referred by his GP on that day due to concerns as to breathlessness. Following admission the working diagnosis was of heart failure, anaemia, fast atrial fibrillation and interstitial lung disease possibly asbestos related. There was a history of weight loss. The combination of this with the shortness of breath and anaemia led the clinicians to seek a CT scan of the chest. Mr Fagg had a CT scan with contrast (chest) on 7/12/17. His renal function was normal and at that stage there were no indications of any kidney problems. The decision to proceed to a CT scan with contrast was entirely appropriate. Renal function was normal on 8/12/17.
An endoscopy had also been requested and this took place on 8/12/17. An endoscopy was entirely necessary in the circumstances of the presentation. The procedure necessarily required the patient be nil by mouth for a number of hours. The patient was stable until 10/12/17 when he developed acute kidney injury. The working diagnosis and indeed cause of death as given by the clinicians was acute kidney injury (non-traumatic) due to contrast induced nephropathy. He was not deemed suitable for dialysis and later died on 14/12/17. Although it is acknowledged that there is an ongoing debate as to whether the contrast presents a risk to kidney function, having regard to the absence of any other factors this was the most likely cause of the kidney injury in this case.

Given the proximity of the endoscopy (which required nil by mouth) to the CT with contrast, the concern which arises is whether Mr Fagg should have been considered for and given intravenous fluids.
The doctor who gave evidence said that having requested an endoscopy he would not necessarily have known when this procedure would take place. It is not suggested that the endoscopy should not have taken place but during the course of the evidence the doctor did raise the point that had he known that the endoscopy was to take place the day after the CT scan with contrast he may have considered intravenous fluids.
The matter of concern is therefore whether a patient, even with normal renal function, should be considered for intravenous fluids in cases where they have had a CT scan with contrast and within a short time frame thereafter are required to undergo a procedure which will necessarily mean they will not be allowed to eat or drink for several hours.