Two Cases of Diabetic Ketoacidosis Associated with Paliperidone Treatment in Schizophrenia

Abstract

Atypical antipsychotics, which have better efficacy and fewer side effects compared to first-generation antipsychotics, are being used increasingly for the treatment of schizophrenia. However, adverse events such as weight gain, diabetes mellitus and abnormal lipid profile have been reported in patients treated with these agents. Diabetic ketoacidosis (DKA) is a rare side effect of atypical antipsychotics, but deserves attention due to its severity. Although various atypical antipsychotics have been reported as causing DKA, there have been no reports showing an association with DKA and paliperidone, which is a recently developed antipsychotic agent. Here, we report two cases of DKA in patients with paliperidone therapy. Both cases had no history of diabetes before use of paliperidone, and DKA was manifested within 2 years of starting paliperidone therapy. Like other atypical antipsychotics, use of paliperidone warrants monitoring for metabolic derangements including DKA.

Diabetic Ketoacidosis Associated With Second Generation Antipsychotics: A Case Study and Review of Literature

“…In addition, DKA is caused by physical or mental stress, such as infection or surgery, in patients with insulin deficiency [ 43 ]. SGA-induced DKA, mediated by the abovementioned mechanisms, may occur even in the absence of previous conditions influencing its occurrence [ 51 , 52 ].…”