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Olanzapine-lnduced hyperglycemic nonketonic coma.

J Roefaro¹, S M Mukherjee

¹Veterans Affairs Boston Healthcare System, MA 02130-4817, USA. roefaro.john@boston.va.gov

The Annals of Pharmacotherapy

|March 23, 2001

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Olanzapine medication can cause severe hyperglycemia, a dangerous increase in blood sugar, leading to coma. Discontinuation of olanzapine therapy normalized glucose levels in this patient.

Area of Science:

Endocrinology
Psychiatry
Pharmacology

Background:

Olanzapine is an atypical antipsychotic medication commonly used for treating schizophrenia and bipolar disorder.
Hyperglycemia and its complications, such as hyperosmolar hyperglycemic nonketotic coma, are known risks associated with certain antipsychotic therapies.
Weight gain is a frequently observed side effect of olanzapine, often linked to metabolic disturbances including insulin resistance.

Observation:

A 51-year-old male patient developed extreme hyperglycemia (1596 mg/dL) and subsequently a hyperosmolar hyperglycemic nonketotic coma.
The patient had been initiated on olanzapine therapy less than six months prior to the event.
A notable increase in blood glucose was observed, despite a normal level recorded two months before the event.

Findings:

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Discontinuation of olanzapine therapy resulted in the normalization of the patient's serum glucose concentration within eight days.
The patient no longer required insulin or other glucose-lowering agents after stopping olanzapine.
The case suggests olanzapine may induce hyperglycemia through mechanisms beyond weight gain, potentially indicating direct effects on glucose metabolism.

Implications:

Clinicians should be vigilant for the development of hyperglycemia in patients treated with olanzapine, even in the absence of significant weight gain.
This case highlights the potential for olanzapine to cause severe metabolic derangements, necessitating careful patient monitoring.
Further research into the specific mechanisms by which olanzapine affects glucose homeostasis is warranted to better manage patient safety.