Treatment of diabetic ketoacidosis associated with antipsychotic medication: literature review

Vuk, Antonia and Baretić, Maja and Matovinović Osvatić, Martina and Filipčić, Igor and Jovanović, Nikolina and Rojnić Kuzman, Martina (2017) Treatment of diabetic ketoacidosis associated with antipsychotic medication: literature review. Journal of Clinical Psychopharmacology, 37 (5). pp. 584-589. ISSN 0271-0749

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BACKGROUND: The second-generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute glucose metabolism dysregulation, which may be associated with the use of SGAs. This study aims to review published reports of patients with schizophrenia and antipsychotic drug-associated DKA, focusing on the effective management of both conditions. ----- METHODS: Using a predefined search strategy, we searched PubMed and EMBASE from their inception to July 2016. The search terms were related to "diabetic ketoacidosis" and "antipsychotic medication." Case reports, case series, and reviews of case series written in English language were included in the review. ----- RESULTS: Sixty-five reports were analyzed. In most patients who developed antipsychotic-associated DKA, 1 or more suspected antipsychotic medications were discontinued. In 5 cases, a rechallenge test was trialed, and in only 1 case, it resulted in the elevation of blood glucose. The majority was subsequently treated with a different SGA in combination with insulin/oral hypoglycemic agents; although approximately a third of patients had a complete resolution of symptoms or could control diabetes with diet only at the point of discharge. ----- CONCLUSIONS: Patients taking antipsychotic medications should be regularly screened for insulin resistance and educated about potential complications of antipsychotic medications. This will allow clinicians to individualize treatment decisions and reduce iatrogenic contribution to morbidity and mortality. To achieve best treatment outcomes, antipsychotic-induced DKA should be treated jointly by psychiatry and endocrinology teams.

Item Type: Article
Additional Information: © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
MeSH: Antipsychotic Agents/adverse effects ; Diabetic Ketoacidosis/chemically induced ; Diabetic Ketoacidosis/complications ; Diabetic Ketoacidosis/diet therapy ; Diabetic Ketoacidosis/drug therapy ; Humans ; Schizophrenia/complications ; Schizophrenia/drug therapy
Departments: Katedra za psihijatriju i psihološku medicinu
Depositing User: Martina Žužak
Status: Published
Matovinović Osvatić, MartinaUNSPECIFIED
Jovanović, NikolinaUNSPECIFIED
Rojnić Kuzman, MartinaUNSPECIFIED
Date: October 2017
Date Deposited: 23 Sep 2019 06:45
Last Modified: 20 Aug 2020 09:49
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