Intravenous-Therapy-Associated Circulatory Overload: A Retrospective Study of Forensic Cases

Abstract

Background and Objective: Intravenous therapy is widely used in clinics to deliver medications and fluids to patients, and overuse may cause intravenous-infusion-associated circulatory overload (IACO) and death. However, forensic data on deaths from the overuse of intravenous therapy are limited. We performed a retrospective study to identify whether causes of death in forensic practice were associated with IACO. Methods: A total of 572 medical-related cases with a history of intravenous infusion who suffered from injuries or illnesses and died after treatment in hospitals were recruited from two centers of forensic medicine between 2002 and 2018. Results: The results demonstrated that 6.47% of cases (37/572) were exposed to an infusion overdose that resulted in deaths related to IACO, and 43.24% of cases (16/37) had a net fluid retention ranging from 3.0 L/d to 13.8 L/d. The highest case was administered 1.4 L blood products and 13.6 L fluids within 25 h. We observed significant decreases in red blood cells, hematocrit, hemoglobin, and platelets from the time of “on admission” to “before death”, except for white blood cells. Autopsy findings of 16 cases revealed some organ or tissue pathological alterations related to IACO, including pale-yellow liquid overflow under the abdominal epidermis, much transudate in body cavities, and lung edema with a high tissue density and no obvious slurry deposition in the alveolar lumen. Another 21 cases died after a rapid infusion rate ranging from 111 to 293 drops/min, which resulted from viral myocarditis on autopsy. Conclusions: Our data on excessive or irrational use of intravenous therapy indicate a severe circulatory overload, which may eventually result in lethal outcomes. Therefore, the use of improper intravenous therapy should be reduced to ameliorate adverse health consequences during clinical treatment.