Endocrinol Metab.  2010 Sep;25(3):231-235. 10.3803/EnM.2010.25.3.231.

New Onset Diabetic Ketoacidosis Associated with Quetiapine

• Lee SH

• KMID: 2169067
• DOI: http://doi.org/10.3803/EnM.2010.25.3.231

Abstract

New onset diabetes and diabetic ketoacidosis have been reported with administering atypical antipsychotics. Whereas clozapine and olanzapine are associated with a relatively high incidence of new onset diabetes and diabetic ketoacidosis, there are few case reports that have has been documented implicating quetiapine as the contributor to causing diabetes and diabetic ketoacidosis. I report here on a case of diabetic ketoacidosis that developed in a patient who was associated with quetiapine therapy. A 32-year-old woman with schizophrenia was transferred to the emergency room with diabetic ketoacidosis and vaginal bleeding. Seventeen months before this episode, she was hospitalized in an inpatient psychiatric institution and treated with quetiapine 1200mg, haloperidol 3mg, diazepam 5mg and benztropine 3mg with normal blood glucose levels. She had no personal and familial history of diabetes mellitus. She had no risk factors for diabetes mellitus and she also had no precipitating factor for diabetic ketoacidosis except for taking the atypical antipsychotic quetiapine. I believe that this case is the first case report of quetiapine associated diabetic ketoacidosis in Korea. Considering the unpredictability of hyperglycemia associated with quetiapine, monitoring the blood glucose should be part of the routine care when administering quetiapine.

Keyword

Diabetic Ketoacidosis; Quetiapine

MeSH Terms

Adult
Antipsychotic Agents
Benzodiazepines
Benztropine
Blood Glucose
Clozapine
Diabetes Mellitus
Diabetic Ketoacidosis
Diazepam
Dibenzothiazepines
Emergencies
Female
Haloperidol
Humans
Hyperglycemia
Incidence
Inpatients
Korea
Precipitating Factors
Risk Factors
Schizophrenia
Uterine Hemorrhage
Quetiapine Fumarate
Antipsychotic Agents
Benzodiazepines
Benztropine
Blood Glucose
Clozapine
Diazepam
Dibenzothiazepines
Haloperidol

Reference

1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009. 32:1335–1343.

2. American Diabetes Association. American Psychiatric Association. American Association of Clinical Endocrinologists. North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004. 27:596–601.

3. Lee SH, Yi KH, Kim EA, Hong SB, Nam MS, Kim YS. Two cases of diabetic ketoacidosis associated with atypical antipsychotics. J Korean Diabetes Assoc. 2005. 29:566–570.

4. Koller EA, Weber J, Doraiswamy PM, Schneider BS. A survey of reports of quetiapine-associated hyperglycemia and diabetes mellitus. J Clin Psychiatry. 2004. 65:857–863.

5. Tecott LH, Sun LM, Akana SF, Strack AM, Lowenstein DH, Dallman MF, Julius D. Eating disorder and epilepsy in mice lacking 5-HT2c serotonin receptors. Nature. 1995. 374:542–546.

6. Meyer JM. Effects of atypical antipsychotics on weight and serum lipid levels. J Clin Psychiatry. 2001. 62:27–34.

7. Jin H, Meyer JM, Jeste DV. Phenomenology of and risk factors for new-onset diabetes mellitus and diabetic ketoacidosis associated with atypical antipsychotics: an analysis of 45 published cases. Ann Clin Psychiatry. 2002. 14:59–64.

8. Chintoh AF, Mann SW, Lam L, Giacca A, Fletcher P, Nobrega J, Remington G. Insulin resistance and secretion in vivo: effects of different antipsychotics in an animal model. Schizophr Res. 2009. 108:127–133.

9. Houseknecht KL, Robertson AS, Zavadoski W, Gibbs EM, Johnson DE, Rollema H. Acute effects of atypical antipsychotics on whole-body insulin resistance in rats: implications for adverse metabolic effects. Neuropsychopharmacology. 2007. 32:289–297.

10. Henderson DC, Cagliero E, Copeland PM, Borba CP, Evins E, Hayden D, Weber MT, Anderson EJ, Allison DB, Daley TB, Schoenfeld D, Goff DC. Glucose metabolism in patients with schizophrenia treated with atypical antipsychotic agents: a frequently sampled intravenous glucose tolerance test and minimal model analysis. Arch Gen Psychiatry. 2005. 62:19–28.

11. Henderson DC, Cagliero E, Copeland PM, Louie PM, Borba CP, Fan X, Freudenreich O, Goff DC. Elevated hemoglobin A1c as a possible indicator of diabetes mellitus and diabetic ketoacidosis in schizophrenia patients receiving atypical antipsychotics. J Clin Psychiatry. 2007. 68:533–541.

12. Dixon L, Weiden P, Delahanty J, Goldberg R, Postrado L, Lucksted A, Lehman A. Prevalence and correlates of diabetes in national schizophrenia samples. Schizophr Bull. 2000. 26:903–912.

13. Shiloah E, Witz S, Abramovitch Y, Cohen O, Buchs A, Ramot Y, Weiss M, Unger A, Rapoport MJ. Effect of acute psychotic stress in nondiabetic subjects on beta-cell function and insulin sensitivity. Diabetes Care. 2003. 26:1462–1467.

14. Barnes TR, Paton C, Cavanagh MR, Hancock E, Taylor DM. UK Prescribing Observatory for Mental Health: A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophr Bull. 2007. 33:1397–1403.

15. Marlowe KF, Howard D, Chung A. New onset diabetes with ketoacidosis attributed to quetiapine. South Med J. 2007. 100:829–831.

16. Sirois F. New-onset diabetic ketoacidosis associated with quetiapine: a case report. Gen Hosp Psychiatry. 2008. 30:587–588.

17. Rashid J, Starer PJ, Javaid S. Pancreatitis and diabetic ketoacidosis with quetiapine use. Psychiatry (Edgmont). 2009. 6:34–37.

18. Meyer JM, Leckband SG, Loh C, Moutier CY. Quetiapine-induced diabetes with metabolic acidosis. Int Clin Psychopharmacol. 2004. 19:169–171.

19. Linfoot P, Bergstrom C, Ipp E. Pathophysiology of ketoacidosis in Type 2 diabetes mellitus. Diabet Med. 2005. 22:1414–1419.