Treatment of diabetic ketoacidosis associated with antipsychotic medication: literature review

Scientific paper - Review paper

• Author: Antonia Vuk
• Author: Maja Baretić
• Author: Martina Matovinović Osvatić
• Author: Igor Filipčić
• Author: Nikolina Jovanović
• Author: Martina Rojnić Kuzman
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

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.

• Keywords (english): 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
• Language: english
• Publication type: Scientific paper - Review paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Journal of Clinical Psychopharmacology
• Numbering: vol. 37, no. 5, pp. 584-589
• p-ISSN: 0271-0749
• DOI: https://doi.org/10.1097/JCP.0000000000000772
• URN:NBN: urn:nbn:hr:105:275105
• Publication: 2017-10
• Document URL: https://doi.org/10.1097/JCP.0000000000000772
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:19:43