Aripiprazole-Induced Diabetic Ketoacidosis: Remaining Vigilant

Abstract

Purpose: A case of hyperglycemia and subsequent diabetic ketoacidosis (DKA) possibly associated with aripiprazole use in an adult patient with no previous history of diabetes mellitus is reported. Summary: A 55-year-old man presented to the emergency department with altered mental status and complaints of nausea, vomiting, and abdominal pain. The patient's past medical history was significant only for depression and hyperlipidemia. His home medications included sertraline 200 mg once daily and aripiprazole 10 mg once daily, which was initiated 6 months prior. The patient had no documented history of diabetes mellitus. Laboratory test results at the time of admission revealed hyponatremia, elevated serum creatinine, a blood glucose of 714 mg/dL, elevated amylase and lipase, and ketonuria. The patient's hemoglobin A 1C was 13.5%. DKA was diagnosed. The patient was admitted to the hospital and given a normal saline bolus and infusion. Home medications were not continued. An insulin infusion was also initiated. On the second day of admission, his blood glucose continued to decrease, the insulin infusion was slowly titrated down, and NPH was started. On hospital day 3, the NPH was increased and the insulin infusion was discontinued. The patient was discharged home following 4 days of hospitalization on insulin therapy and aripiprazole was not restarted. Conclusions: Although the glucose dysregulatory effect of aripiprazole is not widely appreciated, our case report emphasizes the importance of monitoring patients who receive any atypical antipsychotic, particularly aripiprazole, for glucose and metabolic abnormalities.