Clozapine-Induced Diabetic Ketoacidosis: A Case Report

Abstract

The objective of this study was to report a case of a person with psychiatric illness treated with clozapine presented with diabetic ketoacidosis (DKA). A clinical monitoring was done on a 38-year-old Indian man affected by schizoaffective disorder, bipolar type presented with DKA after 3 months of clozapine therapy (250 mg/day). After treatment of DKA and discontinuation of clozapine, the patient improved symptomatically, his blood sugar levels normalized and insulin requirements also decreased. This report thus highlights that clinicians should be vigilant about the potential risk of new-onset diabetes and DKA in patients taking clozapine and utilize appropriate clinical and laboratory monitoring early in the course of treatment to prevent serious adverse effects.

Relationship Between Proton-Pump Inhibitor Use and Lower Blood Magnesium Levels

“…DM can decrease magnesium levels. Decreased magnesium levels in patients with diabetes may be caused by a lack of intake of foods high in magnesium, the high excretion of magnesium in the kidney, deficiency/ insulin resistance, decreased absorption of magnesium in the kidney, insensitivity to insulin that affects magnesium transport and glucose metabolism, metabolic acidosis (diabetic ketoacidosis), and the use of loop diuretics and thiazide [15][16][17][18]. The results of this study indicate that DM does not affect the levels of magnesium, which is similar to the results reported by Takeda et al [12].…”

The Clozapine Effect on Blood Glucose Levels, Leukocytes and Platelets in Schizophrenic Patients in the Mental Service Unit of Banyumas Hospital

“…(2-tailed) dan nilai t, diketahui bahwa ada perbedaan rata-rata antara nilai kadar glukosa darah pre-dan post-test yang artinya ada pengaruh penggunaan clozapin terhadap peningkatan kadar glukosa darah pasien dengan nilai p value < 0.05 (95 % kepercayaan) dan nilai rata-rata (mean) selisih kadar glukosa darah pada pre dan post test ialah 26.750 mg/dL dan selisih perbedaan tersebut antara -38,482 sampai -15.018 (95% Confidence interval of the Difference Lower dan Upper) . Data tersebut sejalan dengan penelitian sebelumnya yang menyebutkan bahwa terjadi peningkatan kejadian hiperglikemi gada penggunaan Clozapine jangka panjang yang disebabkan karena kehilangan kontrol glukosa, penurunan sensitivitas insulin dan peningkatan uptake glukosa terutama pada penggunaan lebih dari 12 minggu (Alex et al, 2018;Grajales, Ferreira and Valverde, 2019). Clozapine mampu meningkatkan kejadian hiperglikemi melalui abnormalitas pada IGFBP-1 (Insulin like Growth Factor Binding Protein-1) yang diindikasikan menyebabkan disfungsi glukoregulatori (Howes et al, 2004).…”