Emphysematous pancreatitis predisposed by Olanzapine

Abstract

A 32-year-old male presented to our intensive care unit with severe abdominal pain and was diagnosed as acute pancreatitis after 2 months of olanzapine therapy for bipolar disorder. His serum lipase was 900 u/L, serum triglyceride 560 mg/dL, and blood sugar, fasting and postprandial were 230 and 478 mg/dL, respectively on admission. Contrast enhanced computed tomography (CECT) of abdomen was suggestive of acute pancreatitis. Repeat CECT showed gas inside pancreas and collection in peripancreatic area and patient underwent percutaneous drainage and antibiotics irrigation through the drain into pancreas. We describe the rare case of emphysematous pancreatitis due to development of diabetes, hypertriglyceridemia and immunosuppression predisposed by short duration olanzapine therapy.

Olanzapine-induced acute necrotising pancreatitis leading to recurrent multiple organ dysfunction syndrome

“…Clinicians in all cases were confident in ruling out any confounders of acute pancreatitis, in particular alcohol, gallstones and other drugs. The majority of the cases made use of radiological investigation to rule out cholelithiasis [1][2][3][4][5][6][7][8] (one exception was a patient with a previous history of cholecystectomy within the decade prior to presentation 9 ). In addition, a concurrent accidental verapamil overdose may have confounded one case, but the authors proposed that olanzapine was the causative agent.…”

“…Seven cases measured and documented acute hypertriglyceridaemia in the context of olanzapine use. [4][5][6][7][8] Plasmapheresis was required and integral to recovery in one patient with a profoundly raised triglyceride level. 4 Authors from gastroenterology recommended that patients be screened and treated for hypertriglyceridaemia prior to starting treatment with olanzapine.…”

“…Olanzapine has been observed and documented to be associated with acute pancreatitis. [1][2][3][4][5][6][7][8][9][10] The likelihood of adverse events due to olanzapine is possible on average according to the Naranjo Scale (a validated adverse drug event rating scale). 11 The likely mechanism of action is acute hypertriglyceridaemia.…”

Analysis of the clinical characteristics of olanzapine-induced acute pancreatitis

“…Three patients complained of weight gain. 11 – 13 Two patients had acute pancreatitis with ketoacidosis. 12 , 13 One patient was infected with COVID-19.…”