[From prison with coma]

Area of Science:

• Endocrinology
• Psychiatry
• Clinical Pharmacology

Background:

• Second-generation antipsychotics are frequently prescribed for psychotic disorders.
• These medications are known to cause metabolic disturbances, including weight gain, hyperglycemia, and dyslipidemia.
• Managing somatic conditions in patients with psychiatric disorders requires a multidisciplinary approach.

Observation:

• A 42-year-old male patient was discovered unconscious in his prison cell.
• Medical investigations revealed previously unrecognized diabetes mellitus.
• The diabetes was suspected to be secondary to the use of prescribed antipsychotic medications.

Findings:

• The patient presented with diabetic ketoacidosis, a severe complication of diabetes, despite no prior diagnosis.
• This case illustrates a severe, albeit rare, side effect of second-generation antipsychotics in individuals without acknowledged diabetes.
• Antipsychotic-induced metabolic changes necessitate vigilant monitoring for glycemic control.

Implications:

• Healthcare providers must be aware of the potential for severe metabolic side effects, such as diabetic ketoacidosis, associated with antipsychotic use.
• A collaborative, multidisciplinary approach involving various medical specialties is crucial for managing psychiatric patients with co-existing somatic conditions.
• Adherence to updated clinical guidelines, such as Norwegian guidelines, can assist clinicians in navigating complex patient cases and managing drug side effects effectively.