A inquest into the death of a man in the intensive care unit of a Dublin hospital has heard that the complicated medical condition which caused his death is a new area of medicine and there is a lot that is not known.
Éamon Kennard (34), Celbridge, Co Kildare, was seen by 14 or 15 specialists at Beaumont hospital before he died in the intensive care unit at 1.40am on August 6th, 2005.
The symptoms of his complicated illness included jaundice, sepsis, acute renal failure and the destruction of muscles. Mr Kennard had been discharged from the the intensive care unit just over a day before his death.
The inquest at Dublin City Coroner's Court heard yesterday that Mr Kennard's death may have been caused by a rare and possibly genetic condition called mitochondrial myopathy.
The professor of neuropathology at Beaumont, Prof Michael Farrell, told the court that upon examination of Mr Kennard's body, he discovered widespread damage or necrosis to the fibres of Mr Kennard's muscles.
"I found there was sufficient evidence that the cause of his muscle fibre destruction might have been caused by a deficiency in the mitochondrial mechanism."
His muscle cells were also deficient in an enzyme required for normal mitochrondial function.
Prof Farrell said he was unable to say whether the condition was genetic or sporadically caused by infection, stress or drugs. "This is a relatively new area of medicine and there's a lot we don't know. I can't say what the cause of death is."
Pathologist Dr Muna Sabah, told the coroner's court that Mr Kennard died from respiratory failure. In her opinion, the respiratory failure was secondary to mitochondrial myopathy in a patient with a background of cirrhosis and acute renal failure, secondary to rhabdomyolysis - the destruction of skeletal muscle cells.
Barrister for the Kennard family Dr Ciarán Craven said he was not satisfied that mitochondrial disease was the primary cause of Mr Kennard's death.
"When it comes to the causative role of mitochondrial myopathy, Prof Farrell was unable to say whether it is the primary event or a secondary event," Dr Craven said. "Mitochondrial myopathy may well represent the final paths, but it's insufficient to rely on Dr Sabah's finding that this is the only cause of death in this instance."
Dr Ciara Magee, who first saw Mr Kennard on July 13th, 2005, said the decision to discharge him from the intensive care unit on August 4th would have been made by the intensive care team under Dr Michael Power.
She told the court that Mr Kennard was given Lorasepam, a type of medication used to treat anxiety, three times on the day before he died, but said the medication caused no depression of his respiration.
Dr Claire Smyth said in relation to the decision to treat Mr Kennard with Lorasepam, she "was concerned that he had such a significant anxiety level". It was appropriate to administer the medication.
Prof Farrell said that in his opinion, Mr Kennard's state of anxiousness was due to a lack of oxygen in the tissues of his cells.
The court hear that while an X-ray of Mr Kennard was ordered at some time on the morning of August 4th, it had not been carried out by the time Dr Magee left the hospital between 6pm and 7pm that evening.
Coroner Dr Brian Farrell adjourned the inquest to seek further evidence from medical staff who cared for Mr Kennard in the 3½ hours before his death - from 10pm on August 5th to 1.30am on August 6th.
He said he was concerned that there was a gap in the story, with no direct evidence heard from any of the medical staff who looked after Mr Kennard on the morning of his death.