Olanzapine-induced hyperglycaemic coma and neuroleptic malignant syndrome: case report and review of literature

Abstract

Although the relationship between antipsychotic medication, particularly second-generation antipsychotics (SGAs), and metabolic disturbance is increasingly accepted, there is an important, but little recognised, potential interaction between this and the other important serious adverse effect of neuroleptic malignant syndrome (NMS). We report a case of a 35-year old female who developed new onset type II diabetes mellitus with hyperosmolar hyperglycaemic coma and acute renal failure following treatment with a SGA for a first manic episode. The history is strongly suggestive of concurrent NMS. This case raises important questions about non-ketotic, hyperosmolar diabetic coma with antipsychotics, the possible association between hyperglycaemia and hyperthermia, and the direction of causality in this, the recognition of either syndrome when they co-exist and management issues in such patients. These questions are considered in the context of currently available literature.

Olanzapine-Induced Neuroleptic Malignant Syndrome with Hypernatremia

“…It is not clear, but the occurrence of hypodipsic hypernatremia which is related to the patients' negative symptoms, may be the key factor in this case (5). Dehydration also impairs dissipation of heat by causing vasomotor constriction and predisposes to NMS (6).…”

The Impact of Hyperosmolarity on Long-Term Outcome in Patients Presenting with Severe Hyperglycemic Crisis: A Population Based Study

“…A few case reports of HHS precipitated by diuretic use have been described [13]. Although antipsychotics and antidepressants are well known precipitators of both HHS and diabetic ketoacidosis [14], little is known about the role of benzodiazepines in these clinical entities. Benzodiazepines are associated with a number of adverse effects including daytime sedation and slowed psychomotor performance [15], both of which may predispose to dehydration, progression of kidney disease, and eventually HHS.…”

A case of a patient with hyperosmolar hyperglycemic state: Implications for nurse practitioners in primary care

“…There are also cases of focal neurologic deficits presenting like stroke or seizure that resolve with insulin and hydration (Nugent, ). There are cases of neuroleptic drugs such as olanzapine being implicated as the inciting cause, and the patient presents with a fever not from infection but from neuroleptic malignant syndrome (Ahuja, Palanichamy, Mackin, & Lloyd, ). While infection is the most common known cause of HHS, a variety of other events can trigger the process, as listed in Table .…”