Olanzapine Induced Diabetic ketoacidosis: An ...

Olanzapine Induced Diabetic ketoacidosis: An Overlooked Metabolic Disorder in Psychiatric Patients

Author Name : Treesa Mariya, Dr. Lincy George

DOI: https://doi.org/10.56025/IJARESM.2023.1201242071

ABSTRACT Olanzapine is a second-generation antipsychotic medication. In the treatment of schizophrenia, atypical antipsychotics have supplanted conventional antipsychotics due to their reduced propensity to induce unwanted neurologic side effects, such as tardive dyskinesia, extrapyramidal symptoms, and neuroleptic malignant syndrome (NMS). Atypical antipsychotics, however, have been linked to a number of metabolic side effects, including diabetes, reduced glucose tolerance, and even diabetic ketoacidosis (DKA). Here we describe a newly diagnosed case of diabetic ketoacidosis in a patient who started taking olanzapine 5 years before she was presented. A 29-year-old Indian female presented with a 2 week history of anorexia, polydipsia and a sudden onset of giddiness associated with dyspnea. Her past medical history included paranoid schizophrenia and hypothyroidism. At the time of admission patient was taking olanzapine 5 mg, thyroxine 50 mcg and trifluoperazine/benzhexol hydrochloride 5/2 mg daily. Her physical exam upon admission included severely dry mucous membranes and labored respirations. The GRBS level was 410 mg/dL, anion gap 25.6 mmol/L, hemoglobin A1c (HgbA1c) 12.8%, arterial pH 6.98, TSH > 100.0 uIU/ml. She was treated with intravenous fluids, sodium bicarbonate and continuous insulin infusion soon after hospitalization and olanzapine was discontinued. She was discharged on Inj. Huminsulin and oral hypoglycemic agents. Five months after discharge, she indicated not taking any of the prescribed insulin or metformin. At this follow-up, her HgbA1c was 6.7%. Our case report emphasizes the need for regular screening of patients requiring diabetogenic drugs, so that early identification of possible side effects can be noted and averted.