Endocrinol Metab.  2013 Mar;28(1):70-75. 10.3803/EnM.2013.28.1.70.

Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report

• Sa YK
• Yang H
• Jung HK
• Son JW
• Lee SS
• Kim SR
• Cha BY
• Son HY
• Pae CU
• Yoo SJ

• KMID: 1805950
• DOI: http://doi.org/10.3803/EnM.2013.28.1.70

Abstract

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

Keyword

Diabetic ketoacidosis; Neuroleptic malignant syndrome; Olanzapine

MeSH Terms

Acute Kidney Injury
Antipsychotic Agents
Benzodiazepines
C-Peptide
Diabetic Ketoacidosis
Fluid Therapy
Follow-Up Studies
Glucose
Humans
Incidence
Insulin
Movement Disorders
Neuroleptic Malignant Syndrome
Renal Dialysis
Rhabdomyolysis
Schizophrenia
Antipsychotic Agents
Benzodiazepines
C-Peptide
Glucose
Insulin

Figure

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  Fig. 1 Nonenhanced computed tomography showed no definite pancreatic parenchymal infiltration or abnormal fluid collection.

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  Fig. 2 Intensive glycemic control using insulin resulted in remarkably improved serum glucose levels. MDI, multiple dose injection.

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  Fig. 3 Bone scan. Blue arrows indicated mild uptake at both the upper proximal and lateral thigh and buttock.

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  Fig. 4 Serum creatine phosphokinase level gradually decreased after initiation of dialysis and discontinuation olanzapine treatment. CPK, creatine phosphokinase; CRRT, continuous renal replacement therapy; HD, hemodialysis.

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