Did a weight-loss shot contribute to this grandmother’s death?

Caroline Savage, 73, had been privately prescribed the weight-loss drug for about four months but fell seriously ill shortly after being advised to raise the amount she was taking.

She died from fecal peritonitis — a leaking of fecal matter into the abdominal cavity — caused by perforation of part of her intestines on Oct. 19, 2024.

An inquest into her death at Norfolk's Coroner Court has been examining the extent to which it may be linked to the weight loss drug, which is known to have gastrointestinal side effects.

But the hearing has also been told of concerns from her family that doctors who treated her in hospital may have been too keen to attribute her symptoms to the drug.

Her family, represented by barrister Jasmine Leng, argued that her symptoms should have prompted further investigation rather than dismissed as side effects.

Savage, from Wortwell, England, had been taking Mounjaro to lose weight and ease symptoms associated with lipedema.

The mother and grandmother had previously been unsuccessful in losing weight through diet and exercise and had weighed 128 kilograms (282 pounds) in July 2024.

Her private prescribing doctor, Dr. Harvinder Chahal, said Savage was warned that possible side effects included abdominal pain and constipation.

When she was reviewed in October, her weight had fallen to 114 kilograms (251 pounds) and she reported feeling well, with no significant side effects.

She was advised to complete the two remaining 7.5 mg doses in her existing pen before increasing to 10 mg.

But Savage developed acute and constant abdominal pain on the morning of Oct. 18 and an ambulance was called at 1:30 p.m.

She was taken to the Norfolk and Norwich Hospital's rapid assessment and treatment area at about 2:45 p.m. but remained in an ambulance because the emergency department was too busy.

She was assessed by a senior clinical fellow in emergency medicine who said his initial concern was pancreatitis, a known but rare complication associated with weight-loss medication.

However, Savage's blood results did not indicate pancreatitis and, following examination, he concluded she did not require admission or a CT.

Advanced clinical practitioner Laura Rea said Mounjaro's recognized side effects, including abdominal pain and bloating, formed a reasonable working diagnosis in the absence of any evidence pointing toward a surgical emergency.

Dr. Olmo-Ferrer, a consultant in emergency medicine, also reviewed Savage and carried out a focused ultrasound to rule out an abdominal aortic aneurysm.

He said she appeared comfortable enough to be discharged with pain relief and advice, adding there was no clinical indication for a CT scan or referral to other specialties.

She was discharged from hospital at about 6:30 p.m., but collapsed at home just after midnight.

Her husband Jeremy, a former Tory councilor, heard a thud and found his wife unresponsive on the floor.

He called an ambulance and attempted CPR, but she could not be saved.

A postmortem examination found Savage had died from fecal peritonitis.

While there is no established evidence that this can be caused by Mounjaro, possible links were discussed at the hearing.

The drug slows the process by which food moves from the stomach to the intestine, and constipation is a known side effect.

The hearing was told that if someone already unknowingly had diverticular disease — a condition that affects the intestine — the side effects from Mounjaro could increase pressure in the intestines and therefore the risk of inflammation and perforation.

But a report said the impact was impossible to quantify.

Much of the inquest, held before area coroner Yvonne Blake, focused on Savage's use of Mounjaro and whether sufficient investigations were carried out by hospital staff before she was sent home.

They argued she had been discharged without a proper diagnosis and questioned why no surgical review, CT scan or further investigation was undertaken before she was allowed home.

Following her death, the hospital carried out a review of her care.

Consultant Dr. Hussain Hommad told the inquest that her presentation, blood tests, observations and ultrasound findings were all within normal limits at the time she was assessed.

He said diverticular perforation was extremely difficult to predict and clinicians had acted appropriately based on the information available.

Although Mounjaro has since become associated with increased risks of gallstones and bowel obstruction, he said its use alone does not currently lower the threshold for carrying out CT imaging.

The family's barrister submitted that Article 2 of the European Convention on Human Rights — the right to life — should be engaged because of potential systemic failures in communication, documentation and clinical decision-making at the hospital.

She argued clinicians repeatedly assessed Savage's pain shortly after morphine had been administered and may not have appreciated the significance of that when deciding whether further investigations were needed.

Solicitor Alison Brockhurst, representing the Norfolk and Norwich University Hospitals NHS Foundation Trust, argued Savage's death was from natural causes and the high threshold for engaging Article 2 had not been met.

She accepted record keeping "wasn't as good as it could have been" but said evidence showed detailed discussions had taken place between clinicians in person and that appropriate pathways had been followed.

Blake said she required further time to consider the legal submissions before deciding whether Article 2 should apply.

She adjourned that decision and said she would later return to deliver her narrative conclusion.