Vol 41 # 3 September 2009 - Kma.org.kw

September 2009
KUWAIT MEDICAL JOURNAL 241
Fig. 1: Graph showing the relationship between urine sugar, urine ketones and discontinuation of olanzapine
insulin was tapered and he was normoglycemic
without insulin after one month of discharge.
Olanzapine was replaced with risperidone
for the treatment of worsening of his negative
schizophrenic symptoms.
DISCUSSION
Data from most studies suggest that the
prevalence of both DM and obesity among
individuals with schizophrenia and schizoaffective
disorders is 1.5 – 2.0 times higher than
in the general population [1,2] . In the treatment
of schizophrenia, atypical antipsychotics are
preferred over conventional antipsychotics
due to lack of adequate response of negative
symptoms and high rate of extra-pyramidal side
effects of conventional antipsychotics [3] . Atypical
Table 1: Baseline blood and urinary parameters of the patient on
olanzapine presenting with diabetic ketoacidosis (DKA)
Variables
Blood sugar (mmol/l)
Blood pH
Bicarbonate (mmol/l)
Potassium (mmol/l)]
Sodium (mmol/l)]
Chloride (mmol/l)
Urine sugar
Urine ketones
Patient
value
39.4
7.219
7.8
3.8
130
98.2
+++
+++
Variables
Creatinine (mmol/l)
BUN (mmol/l)
Total cholesterol
(mmol/l)
Triglycerides (mmol/l)
Uric acid (μmol/l)
Lactate (mmol/l)
(NR: 0.50 – 2.20)
WBC count (× 10 9 /l)
D-Dimer (ng/ml)
Patient
value
140
6.4
6.43
5.23
639
0.92
5.92
< 250
antipsychotic drugs especially olanzapine and
clozapine have been found to induce weight
gain, hypercholesterolemia, hypertriglyceridemia
and DM. However DKA is extremely rare as a
Fig. 2: Graph showing the relationship of olanzapine with metabolic dysregulation