X-rays show ‘foreign objects’ were unchewed tablets – inquest

Doctors initially concerned about a number of “foreign objects” in the stomach of a man with pneumonia found they were merely unchewed tablets, an inquest has heard.

The medication, used to treat chronic kidney disease, is large, disc-shaped and ineffective if not taken correctly.

X-rays performed on Patrick O’Brien (47), a father of six from Hazelwood, Bray, Co Wicklow, showed several large discs “like Silvermints” after he was admitted to hospital in April 2014.

The find aroused concern among medics who were initially unable to identify the objects.

Mr O’Brien, who suffered from end-stage kidney disease and cirrhosis of the liver, was taking 52 tablets a day, according to his wife Helena O’Brien.

He had been prescribed lanthanum tablets for the treatment of chronic kidney disease, but was swallowing them whole instead of chewing them as directed, Dublin Coroner’s Court heard.

“Those tablets used to cause a very bad taste in his mouth, so he used to swallow them whole,” Mrs O’Brien said.

Mr O’Brien was on dialysis but frequently missed appointments.

“He was very sick for three years, in the end he could hardly eat or walk, he could hardly get out of bed,” his wife said.

Dr John Holian, consultant nephrologist at St Vincent's Hospital in Dublin, said the medical team could not perform a biopsy on Mr O'Brien because he was at risk of excessive bleeding.

“At the time we were not really sure what they were, they looked quite unusual . . . like big Silvermints,” he said.

Mr O’Brien was admitted to St Vincent’s on April 24th with a small bowel obstruction and died on May 1st. The cause of death was acute bronchial pneumonia with evidence of chronic pulmonary aspiration on a background of end stage kidney and liver disease.

It was feared he had been inhaling his lanthanum medication and that had contributed to his death. However, a postmortem examination showed he had been aspirating gastric contents for some time.

Dr Holian said “a lot of time” was spent with patients taking lanthanam explaining the need for the tablets to be crushed or chewed and taken with food to be effective. There is no liquid form, he said.

Mrs O’Brien said a transplant kidney was available to her husband but he was too ill to undergo surgery.

“His niece Bridget was willing to donate a kidney but he was too sick, he would not have survived the (transplant) operation. The hospital did all they could, they were absolutely brilliant to him,” she said.

Coroner Dr Brian Farrell returned a narrative verdict.