Diabetic Ketoacidosis Associated with Aripiprazole

Abstract

Metabolic adverse effects such as hyperglycemia, alterations in insulin sensitivity, and weight gain are known to be potential complications of atypical antipsychotic therapy. In certain cases, hyperglycemia may be so profound that diabetic ketoacidosis (DKA) or hyperosmolar coma may result. Aripiprazole, approved by the United States Food and Drug Administration in 2002, appears to have fewer metabolic adverse effects than other atypical antipsychotics. We describe a 44-year-old man with no personal or family history of diabetes mellitus who was prescribed aripiprazole for schizoaffective disorder. Two weeks after starting this therapy, the patient developed DKA, which was corrected with insulin therapy and aggressive hydration. According to the Naranjo adverse drug reaction probability scale, aripiprazole was the probable trigger of his DKA. An exhaustive search for other causes of DKA was unrevealing. Administration of aripiprazole or any other atypical antipsychotic should be terminated when impaired glucose tolerance is suspected. Vigilance regarding the potential adverse effects of this class of drugs, including new agents such as aripiprazole, is crucial to preventing potentially life-threatening complications of hyperglycemia.

Use of aripiprazole for delirium in the elderly: a short review

“…There were no significant differences with regard to the risk of diabetes . However, some case reports have suggested an association between aripiprazole and drug‐induced diabetic ketoacidosis and increased levels of serum lipase . In a 52‐week double‐blind evaluation of the metabolic effects of aripiprazole and lithium in patients with bipolar I disorder conducted by McIntyre et al ., no significant differences were observed in the changes in metabolic parameters in both treatment groups.…”

“…79 However, some case reports have suggested an association between aripiprazole and drug-induced diabetic ketoacidosis and increased levels of serum lipase. [80][81][82][83][84] In a 52-week double-blind evaluation of the metabolic effects of aripiprazole and lithium in patients with bipolar I disorder conducted by McIntyre et al, 85 no significant differences were observed in the changes in metabolic parameters in both treatment groups. However, a significant difference in body weight increases was observed only among patients with body mass indexes >25: +2.66 kg for aripiprazole and +0.40 kg for lithium.…”

Aripiprazole-Induced Diabetic Ketoacidosis: Remaining Vigilant

“…Three of the 5 reported cases involved concomitant antipsychotic medications. 4,6,7 The Naranjo probability of causality scale for adverse drug reactions was used to assess the relationship between aripiprazole and the development of DKA. 9 A score of 4 was determined, suggesting a possible causal relationship.…”

“…10,11 Four of the published cases of aripiprazole-associated DKA have been associated with weight gain, obesity, or impaired glucose tolerance. [3][4][5][6] The case by Reddymasu specifically reported an increase in body mass index from 32 kg/m 2 to 41 kg/m 2 over the 18 months after aripiprazole initiation. 3 In our patient, the 16 kg weight gain associated with aripiprazole seems to be the mechanism leading to glucose intolerance and subsequent DKA.…”

A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia

“…More recently, two new drugs, aripiprazole and ziprasidone, have been associated with lower rates of adverse metabolic effects than other SGAs (Kudla et al, 2007;L'Italien et al, 2007;Newcomer, 2007a;2007b;Makhzoumi et al, 2008).…”