Abstract
Obstructive asphyxia, also known as cafe coronary, has been linked to both medicated and nonmedicated psychiatric patients. An 18-month prospective audit of choking patients was conducted in a psychiatric hospital. Based upon all medications received in the 5 days preceding the event, mean daily chlorpromazine and atropine equivalent dosages were calculated for 31 patients. Mean daily chlorpromazine and atropine equivalent dosages were also calculated for age, sex, and diagnosis matched controls based upon all medications received during their entire hospital stay. Paired t-tests showed no significant differences between choking patients and their matched controls except that greater mean daily chlorpromazine equivalents were present in the severe choking subgroup. Computation of log odds of choking risk increases with interaction of increased mean doses of each drug type and age, and also with interaction of increased chlorpromazine equivalents and increased atropine equivalents. Patients receiving high dosages of drug(s) with antidopaminergic or anticholinergic activity are at greater risk of choking and should be monitored closely.