Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report

Abstract

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

Discover potential adverse drug reactions using the skip-gram model

“…The reaction "Neuroleptic malignant syndrome (NMS)" is a life-threatening neurological disorder characterized by muscle rigidity, fever, autonomic instability and cognitive changes, and has been shown as an ADR for the olanzapine in some existing research [6]. Therefore, we confirm that NMS is a potential ADR for the olanzapine.…”

Neuroleptic syndrome among patients receiving antipsychotic drugs-review

“…The malignant version of neuroleptic syndrome is quite rare 17,22 . However, the risk of fatality is high regardless of whether the condition is malignant or not 23,24 .…”

Nanoneurotherapeutics approach intended for direct nose to brain delivery

“…Antipsychotic medication is widely associated with dysmetabolism including obesity and type 2 diabetes, cardiovascular-related diseases and early death. Atypical antipsychotics have a lower propensity to cause undesirable neurologic adverse events, such as extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome 118 .…”