quetiapine-fumarate and Diabetic-Ketoacidosis

A 27-year-old man treated with quetiapine for anxiety disorder developed hypertriglyceridaemia-induced acute pancreatitis and diabetic ketoacidosis. He was otherwise physically healthy with no family history of hyperlipidaemia. Despite aggressive intensive therapy he died of multiorgan failure within 36 h from initial presentation. While second-generation antipsychotics are well known to be causally linked to diabetes and hyperlipidaemia, this is to my knowledge the first-described case of a fatal triad of extreme hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine. Clinicians should be aware of this rare clinical presentation since rapid progression to multiorgan failure can occur. Early supportive therapy should be initiated. Lactescent serum and ketoacidosis in severe acute pancreatitis should not be overlooked-initiate insulin therapy and possibly plasmapheresis in case of extreme hypertriglyceridaemia.

Topics: Adult; Antipsychotic Agents; Anxiety Disorders; Delayed Diagnosis; Diabetic Ketoacidosis; Diagnosis, Differential; Dibenzothiazepines; Dose-Response Relationship, Drug; Fatal Outcome; Humans; Hypertriglyceridemia; Male; Pancreas; Pancreatitis, Acute Necrotizing; Phobic Disorders; Psychotic Disorders; Quetiapine Fumarate; Tomography, X-Ray Computed

Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Diabetes Mellitus; Diabetic Ketoacidosis; Dibenzothiazepines; Humans; Mass Screening; Olanzapine; Piperazines; Predictive Value of Tests; Prospective Studies; Quetiapine Fumarate; Quinolones; Severity of Illness Index

Topics: Acromegaly; Acute Disease; Adenoma; Adult; Antipsychotic Agents; Basal Ganglia; Brain Ischemia; Chorea; Diabetes Complications; Diabetic Ketoacidosis; Dibenzothiazepines; Dyskinesias; Female; Growth Hormone; Humans; Hyperglycemia; Insulin; Magnetic Resonance Imaging; Pituitary Gland; Pituitary Neoplasms; Quetiapine Fumarate; Syndrome

A 45-year-old man with paranoid schizophrenia with delusions was transferred from a group home for treatment of diabetic ketoacidosis (DKA). Six months before this episode, he had been hospitalized in an inpatient psychiatric institution and treated with valproic acid and quetiapine 400 mg with normal blood sugars recorded. The patient was treated for diabetic ketoacidosis, and all outpatient medications were discontinued. Insulin resistance is commonly cited as the mechanism for hyperglycemia, a theory supported by the efficacy of insulin- sensitizing medications in reported cases. Although antipsychotic- associated DKA is uncommon, hyperglycemia associated with these medications is commonplace. Analysis of case series have not identified risk factors for hyperglycemia or diabetic ketoacidosis within this population. Considering the incidence and unpredictability of hyperglycemia associated with quetiapine and atypical antipsychotics, clinicians should initiate intensive monitoring in patients, including weight, hyperglycemia, and dyslipidemia.

Topics: Antipsychotic Agents; Diabetes Mellitus; Diabetic Ketoacidosis; Dibenzothiazepines; Drug Therapy, Combination; Humans; Hypoglycemic Agents; Insulin; Male; Middle Aged; Quetiapine Fumarate; Schizophrenia, Paranoid; Treatment Outcome

New onset diabetes mellitus (DM) and diabetic ketoacidosis (DKA) among patients using atypical antipsychotics is of clinical importance [1,2,5,7-10]. Recently, atypical antipsychotics have been more widely used in the treatment of behavioral and psychological symptoms with dementia (BPSD) than conventional neuroleptics because of a reduced tendency for movement disorders and psychomotor retardation. We report a case of reversible DKA and new-onset DM that developed in a demented patient who was treated with quetiapine for 14 days.

Topics: Aged; Alcoholism; Antipsychotic Agents; Dementia; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Dibenzothiazepines; Humans; Male; Quetiapine Fumarate

Medication adherence with antipsychotics is adversely impacted by the burden of untoward adverse effects. In particular, sexual side-effects may interfere with compliance, but are often underreported by patients. Sexual dysfunction related to hyperprolactinemia is commonly described, but ejaculatory disturbance due to potent alpha1 adrenergic antagonism may also occur, and has been reported frequently with certain typical antipsychotics such as thioridazine, but rarely with atypical antipsychotics. Presented here is the case of a 51 year old male with schizophrenia who developed retrograde ejaculation on high dose risperidone therapy (8 mg/day) with prompt resolution of symptoms upon dose reduction. The absence of decreased libido or erectile dysfunction indicates that alpha1 adrenergic antagonism and not low serum testosterone due to hyperprolactinemia is the etiology for this side-effect. This case illustrates another mechanism for sexual adverse effects, and the need for routine inquiry into sexual dysfunction during atypical antipsychotic therapy.

Topics: Antipsychotic Agents; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Dibenzothiazepines; Humans; Male; Middle Aged; Quetiapine Fumarate; Schizophrenia

To explore the clinical characteristics of hyperglycemia in patients treated with quetiapine.. A pharmacovigilance survey of spontaneously reported adverse events in quetiapine-treated patients was conducted using reports from the U.S. Food and Drug Administration MedWatch program (January 1, 1997, through July 31, 2002) and published cases using the search terms hyperglycemia, diabetes, acidosis, ketosis, and ketoacidosis.. We identified 46 reports of quetiapine-associated hyperglycemia or diabetes and 9 additional reports of acidosis that occurred in the absence of hyperglycemia and were excluded from the immediate analyses. Of the reports of quetiapine-associated hyperglycemia, 34 patients had newly diagnosed hyperglycemia, 8 had exacerbation of preexisting diabetes mellitus, and 4 could not be classified. The mean +/- SD age was 35.3 +/- 16.2 years (range, 5-76 years). New-onset patients (aged 31.2 +/- 14.8 years) tended to be younger than those with preexisting diabetes (43.5 +/- 16.4 years, p = .08). The overall male:female ratio was 1.9. Most cases appeared within 6 months of quetiapine initiation. The severity of cases ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma. There were 21 cases of ketoacidosis or ketosis. There were 11 deaths.. Atypical antipsychotic use may unmask or precipitate hyperglycemia.. An additional 23 cases were identified since August 1, 2002, the end of the first survey, by extending the search through November 30, 2003, bringing the total to 69.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Antipsychotic Agents; Child; Child, Preschool; Comorbidity; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Dibenzothiazepines; Female; Humans; Hyperglycemia; Hyperglycemic Hyperosmolar Nonketotic Coma; Male; MEDLINE; Mental Disorders; Middle Aged; Pharmacoepidemiology; Quetiapine Fumarate; Schizophrenia; Sex Distribution; United States; United States Food and Drug Administration

The purpose of the study was to determine the proportion of patients with schizophrenia with a stable regimen of antipsychotic monotherapy who developed diabetes or were hospitalized for ketoacidosis.. Patients with schizophrenia for whom a stable regimen of antipsychotic monotherapy was consistently prescribed during any 3-month period between June 1999 and September 2000 and who had no diabetes were followed through September 2001 by using administrative data from the Department of Veterans Affairs. Cox proportional hazards models were developed to identify the characteristics associated with newly diagnosed diabetes and ketoacidosis.. Of the 56,849 patients identified, 4,132 (7.3%) developed diabetes and 88 (0.2%) were hospitalized for ketoacidosis. Diabetes risk was highest for clozapine (hazard ratio=1.57) and olanzapine (hazard ratio=1.15); the diabetes risks for quetiapine (hazard ratio=1.20) and risperidone (hazard ratio=1.01) were not significantly different from that for conventional antipsychotics. The attributable risks of diabetes mellitus associated with atypical antipsychotics were small, ranging from 0.05% (risperidone) to 2.03% (clozapine).. Although clozapine and olanzapine have greater diabetes risk, the attributable risk of diabetes mellitus with atypical antipsychotics is small.

Topics: Ambulatory Care; Antipsychotic Agents; Benzodiazepines; Clozapine; Diabetes Mellitus; Diabetic Ketoacidosis; Dibenzothiazepines; Hospitalization; Humans; Incidence; Olanzapine; Proportional Hazards Models; Quetiapine Fumarate; Risk Factors; Risperidone; Schizophrenia; United States

Topics: Adult; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Cyclohexanols; Diabetic Ketoacidosis; Dibenzothiazepines; Fatal Outcome; Humans; Male; Quetiapine Fumarate; Schizophrenia, Paranoid; Selective Serotonin Reuptake Inhibitors; Venlafaxine Hydrochloride; Weight Gain

Information from the Ohio Department of Mental Health (ODMH) database was reviewed retrospectively to identify patients at the Cincinnati center treated with an atypical antipsychotic and who had also been evaluated or treated for diabetes mellitus. Blood glucose levels, glucose tolerance, or other evaluations of diabetes had been conducted in 14 of the 126 patients treated with atypical antipsychotics. In 11 of the 14, new-onset, acute, and marked glucose intolerance developed after treatment with clozapine, olanzapine or quetiapine. Of these, six patients required insulin therapy (four only transiently) and five patients developed diabetic ketoacidosis (DKA). Also, glucose metabolism was labile in all cases, and was transient in two cases with subsequent resolution despite on-going antipsychotic therapy. Certain atypical antipsychotics may be associated with new-onset glucose intolerance, including acute diabetes and ketoacidosis. Monitoring for changes in blood glucose levels in patients taking atypical antipsychotics may be indicated. More systematic study data are clearly needed.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Diabetes Mellitus; Diabetic Ketoacidosis; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Ohio; Olanzapine; Pirenzepine; Quetiapine Fumarate; Retrospective Studies