Fatal Diabetic Ketoacidosis and Antipsychotic Medication

Abstract

Hyperglycemia and new onset diabetes have been described with certain antipsychotic medications and some of the initial presentations are fatal diabetic ketoacidosis (DKA). We report 17 deaths due to DKA in psychiatric patients treated with second generation antipsychotic medications. Death certificates and toxicology data were searched for DKA and hyperglycemia. We reviewed the medical examiner records which included the autopsy, toxicology, police, and medical examiner investigators' reports. The decedents ranged in age from 32 to 57 years (average 48 years). There were 15 men and two women. The immediate cause of death was DKA in all. The psychiatric disorders included: 10 schizophrenia, three bipolar/schizophrenia, two bipolar, and two major depression. The most frequent atypical antipsychotic medications found were quetiapine and olanzapine followed by risperidone. In 16 deaths, we considered the medication as primary or contributory to the cause of death.

An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists

“…It is worthwhile to note that some antipsychotic medications, especially quetiapine and olanzapine, have been associated with acute onset of hyperglycemia and ketoacidosis [ 51 ]. Cognitive dysfunction associated with elevated glucose levels may be mistaken for the patient's baseline cognitive deficit resulting in delay in detection of hyperglycemia.…”

Acute-Onset Type 1 Diabetes that Developed During the Administration of Olanzapine

“…The APA guidelines, list SDAs as the first choice for acute treatment (3); however, these drugs are associated with the side effect of glucose intolerance (4-9). This may occasionally trigger a hyperglycemic crisis, and some fatal cases have been reported (5,10-12). The mechanisms underlying the onset of glucose intolerance are reported to be as follows.…”

“…These compounds are listed in the American Psychological Association (APA) guidelines as the first choice in acute phase treatment (3). However, one side effect of these SDAs is glucose intolerance (4-9), which occasionally causes a hyperglycemic crisis, and a few fatal cases have been reported (5,10-12). There are no reports of these drugs being associated with the onset of type 1A diabetes.…”

Fatal hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine

“…Recently, Ely et al 2 reported 17 deaths due to diabetic ketoacidosis in psychiatric patients treated with second-generation antipsychotics. Quetiapine was the most frequently suspected agent.…”