Diabetic Keto-Acidotic (DKA) Coma following Olanzapine Initiation in a Previously Euglycaemic Woman and Successful Continued Therapy with Olanzapine

Abstract

We report the case of a euglycaemic woman whose glucose controlrapidly decompensated following olanzapine initiation leading todiabetic coma. Hyperglycaemia has been associated with chronicpsychotic disorders and antipsychotics for many years. However, it is unusual to see such rapid and life-threatening changes associated with treatment. The case highlights that changes in antipsychotic treatment may be associated with large changes in glucose tolerance, and that it is possible to continue antipsychotic treatment with appropriate diabetic care.

Keywords

antipsychotic diabetes mellitus DKA olanzapine psychosis side-effects

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References

Anonymous (2000) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Diabetes Care 23 (Suppl 1): S4–S19

Anonymous (2002a) American Diabetes Association: clinical practicerecommendations 2002 . Diabetes Care 25 (Suppl 1): S1–S147

Anonymous (2002b) American Diabetes Association: clinical practicerecommendations 2002 . Diabetes Care 25 (Suppl 1): S1–S147

Davis J M , Chen N , Glick I D (2003) A meta-analysis of the efficacy ofsecond-generation antipsychotics . Arch Gen Psychiatry 60: 553–564

Harris M I (1993) Undiagnosed NIDDM: clinical and public health issues . Diabetes Care 16: 642–652

Haupt D W , Newcomer J W (2001) Hyperglycemia and antipsychotic medications . J Clin Psychiatry 62 (Suppl 27): 15–26

Johnson R P , Al Taher M T , Madlock L E , Guo M , Nasdahl C S (2002) Increasing insulin dose for olanzapine-related diabetes . Am J Psychiatry 159: 150–151

Koro C E , Fedder D O , L’Italien G J , Weiss S S , Magder L S , Kreyenbuhl J , Revicki D A , Buchanan R W (3-8-2002) Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study . BMJ 325: 243–243

Maule S , Giannella R , Lanzio M , Villari V (1999) Diabetic ketoacidosis with clozapine treatment . Diabetes Nutr Metab 12: 187–188

10.

Mir S , Taylor D (2001) Atypical antipsychotics and hyperglycaemia . Int Clin Psychopharmacol 16: 63–73

11.

Muench J , Carey M (2001) Diabetes mellitus associated with atypical antipsychotic medications: new case report and review of the literature . J Am Board Fam Pract 14: 278–282

12.

Mukkerjee S , Decina P , Bocola V (1996) Diabetes mellitus in schizophrenic patients . Comp Psychiatry 37: 68–73

13.

Newcomer J W , Haupt D W , Fucetola R , Melson A K , Schweiger J A , Cooper B P , Selke G (2002) Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia . Arch Gen Psychiatry 59: 337–345

14.

Nicolai J , Smith S J , Keunen R W (2001) Simultaneous side effects of both clozapine and valproate . Intens Care Med 27: 943–943

15.

Ragucci K R , Wells B J (2001) Olanzapine-induced diabetic ketoacidosis . Ann Pharmacother 35: 1556–1558

16.

Ryan M C , Collins P , Thakore J H (2003) Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia . Am J Psychiatry 160: 284–289

17.

Saydah S H , Loria C M , Eberhardt M S , Brancati F L (2001) Subclinical states of glucose intolerance and risk of death in the US . Diabetes Care 24: 447–453

18.

Selva K A , Scott S M (2001) Diabetic ketoacidosis associated with olanza-pine in an adolescent patient . J Pediatr 138: 936–938

19.

Straker D , Mendelowitz A , Karlin L (2002) Near fatal ketoacidosis with olanzapine treatment . Psychosomatics 43: 339–340

20.

Turnbull D M , Bone A J , Tames F J , Wilson L , Baird J D , Sherratt H S (1985) The effect of valproate on blood metabolite concentrations in spontaneously diabetic, ketoacidotic, BB/E Wistar rats . Diabetes Res 2: 45–48

21.

Wilson D R , D’Souza L , Sarkar N , Newton M , Hammond C (2003) New-onset diabetes and ketoacidosis with atypical antipsychotics . Schizophr Res 59: 1–6