Severe Hyperglycemic Hyperosmolar Nonketotic Coma in a Nondiabetic Patient Receiving Aripiprazole

Campanella, L.; Lartey, Richard; Shih, Richard D.

doi:10.1016/j.annemergmed.2008.04.002

Cited by 12 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, a number of case reports indicate that the conventional antipsychotic as well as atypical antipsychotic drugs may cause hyperglycemia and even DKA or HHS (26,27). Possible mechanisms include the induction of peripheral insulin resistance and the direct influence on pancreatic β-cell function by 5-HT1A/2A/2C receptor antagonism, by inhibitory effects via α2-adrenergic receptors, or by toxic effects (28).…”

Section: Precipitating Factorsmentioning

confidence: 99%

Hyperglycemic Crises in Adult Patients With Diabetes

et al. 2009

View full text Add to dashboard Cite

Section: Precipitating Factorsmentioning

confidence: 99%

Hyperglycemic Crises in Adult Patients With Diabetes

et al. 2009

View full text Add to dashboard Cite

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…2 We report only the fifth case of hyperglycemia with subsequent diabetic ketoacidosis (DKA) associated with aripiprazole in an adult patient with no previous history of diabetes mellitus. 3–6…”

mentioning

confidence: 99%

Aripiprazole-Induced Diabetic Ketoacidosis: Remaining Vigilant

et al. 2011

View full text Add to dashboard Cite

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.

show abstract

“…31 Associated dehydration is also due in part to inadequate fluid intake because of thirst impairment (stroke, alcohol excess, antipsychotic medications, trauma), especially in HHS. 28,32 Acute management ideally needs an intensive care setting, with very frequent monitoring in the first hours. The cornerstones of treatment are fluids, electrolyte, and insulin administration/replacement, with at least hourly controls.…”

Section: Seminars In Respiratory and Critical Care Medicinementioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

View full text Add to dashboard Cite

This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.

show abstract

Severe Hyperglycemic Hyperosmolar Nonketotic Coma in a Nondiabetic Patient Receiving Aripiprazole

Cited by 12 publications

References 15 publications

Hyperglycemic Crises in Adult Patients With Diabetes

Hyperglycemic Crises in Adult Patients With Diabetes

Aripiprazole-Induced Diabetic Ketoacidosis: Remaining Vigilant

Metabolic and Endocrine Challenges

Contact Info

Product

Resources

About