Diabetic ketoacidosis and olanzapine: Case report and literature review

The use of antipsychotics (AP) is associated with the development of metabolic disorders, such as diabetic ketoacidosis (DKA) and acute dysregulation of glucose metabolism. Hyperglycemic complications from drug use, although rare, are potentially life-threatening, so appropriate follow-up and risk assessment during treatment are necessary. This study reports the case of a patient with bipolar affective disorder using olanzapine who developed severe DKA and reviews the current literature on this association. The research was done in PubMed, Cochrane Database, Scopus, Web of Science, Embase, and Google Scholar databases using the keywords: diabetes mellitus, diabetic ketoacidosis, psychotic disorders, antipsychotics, olanzapine, adverse drug event. Upon analysis of the included epidemiological studies, it was observed that most patients who developed DKA were undergoing treatment with olanzapine and clozapine alone or in combination with other antipsychotics. It was seen that the DKA picture usually occurs between six to twelve months of AP use, similar to the case presented. Before insulin resistance, male gender, and middle age favor the disorder in AP users.