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Psychiatria Danubina, Vol. 29 No. 2, 2017.

Case report

https://doi.org/10.24869/psyd.2017.121

DIABETIC KETOACIDOSIS ASSOCIATED WITH ANTIPSYCHOTIC DRUGS: CASE REPORTS AND A REVIEW OF LITERATURE

Antonia Vuk ; Psychiatric Hospital Sveti Ivan, Zagreb, Croatia
Martina Rojnic Kuzman ; Department of Psychiatry, University Hospital Centre Zagreb and the Zagreb School of Medicine, Zagreb, Croatia
Maja Baretic ; Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
Martina Matovinovic Osvatic ; Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia

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Abstract

Background: Second generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA)
is a rare, but potentially fatal sign of acute glucose metabolism dysregulation linked to the use of SGAs.
The aims of this article are to present patients with a history of psychotic disorders and of severe metabolic diabetic ketoacidosis,
possibly associated with the use of antipsychotics, and to review the current literature on the topic of antipsychotic-induced DKA.
Method: PubMed/Medline and EBSCO databases were searched using the keywords: diabetic ketoacidosis, antipsychotics,
atypical antipsychotics, second generation antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole,
paliperidone, amisulpride and haloperidol. Case reports, case series and reviews of case series were included in the review.
Results: The majority of patients who developed DKA following treatment with antipsychotics were treated with olanzapine and
clozapine in monotherapy or in combination with other antipsychotics. DKA mostly occurred in the first six months of antipsychotic
treatment. Other risk factors included insulin resistance prior to antipsychotic treatment, male gender and middle age.
Conclusion: Clinicians should consider the risk of DKA when starting treatment with SGAs. Preventive measures for patients
with psychotic disorders using antipsychotics should include regular assessment of risk factors and screening for diabetes before and
after administering antipsychotics, especially in the first months of treatment. Whenever possible, polypharmacy should be avoided.

Keywords

diabetic ketoacidosis; antipsychotics; atypical antipsychotics; risk factors

Hrčak ID:

184432

URI

https://hrcak.srce.hr/184432

Publication date:

28.6.2017.

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