J Korean Endocr Soc.  2007 Oct;22(5):376-380. 10.3803/jkes.2007.22.5.376.

Diabetic Ketoacidosis in a Patient with Long-term Clozapine Therapy

• Jeon YJ
• Lee SH
• Jang SN
• Kim ES
• Min JY
• Kim JH
• Hong SH
• Cho JH
• Kwon HS
• Yoon KH
• Cha BY
• Son HY

• KMID: 1523109
• DOI: http://doi.org/10.3803/jkes.2007.22.5.376

Abstract

With the broad use of atypical anti-psychotics, altered glucose metabolism has become an item of concern to clinicians and patients. Among the atypical anti-psychotics, clozapine and olanzapine are associated with a relatively high incidence of diabetic ketoacidosis and newly developed diabetes. We report a case of diabetic ketoacidosis in a patient with long-term clozapine therapy. A 35-year-old male with schizophrenia, treated with clozapine for 9 years was admitted into hospital because of comatous mentality. Although never diagnosed with diabetes before, his clinical features were consistent with diabetic ketoacidosis and shock. The patient's serum amylase and lipase levels were elevated and an abdominal computed tomography showed peripancreatic fat infiltration, suggesting the possibility of acute pancreatitis. The patient's serum glucose levels normalized shortly after clozapine treatment. Moreover, the patient ceased all glucose lowering agents upon hospital discharge, and maintained normal blood glucose levels thereafter. As observed in this case, clinicians should carefully screen and monitor blood glucose levels and other clinical parameters in patients treated with atypical anti-psychotics.

Keyword

Clozapine; Diabetic ketoacidosis; Hyperamylasemia

MeSH Terms

Adult
Amylases
Blood Glucose
Clozapine*
Diabetic Ketoacidosis*
Glucose
Humans
Hyperamylasemia
Incidence
Lipase
Male
Metabolism
Pancreatitis
Schizophrenia
Shock
Amylases
Blood Glucose
Clozapine
Glucose
Lipase

Figure

• 

  Fig. 1 Non-enhanced computed tomography shows hazy peripancreatic fat infiltration and mild fatty change of pancreas which is suggestive of acute pancreatitis (A). On follow-up imaging on the 4th hospital day, there was little interval change and no evidence of parenchymal necrosis could be seen (B).

• 

  Fig. 2 The patient's blood glucose level improved shortly after discontinuation of clozapine.

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