Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis
Hui Fang, Clarissa Ern Rafey, Mohammed Faraz Cunningham, Aine Dinneen, Sean F Finucane, Francis M
Hui Fang, Clarissa Ern
Rafey, Mohammed Faraz
Cunningham, Aine
Dinneen, Sean F
Finucane, Francis M
Publication Date
2018-05-10
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Hui Fang, Clarissa Ern; Rafey, Mohammed Faraz; Cunningham, Aine; Dinneen, Sean F; Finucane, Francis M (2018). Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis. Endocrinology, Diabetes and Metabolism Case Reports ,
Abstract
A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m(2)). Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA), with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with 'ketosis-prone diabetes' (KPD) rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c) level had normalised.
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Bioscientifica
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Attribution-NonCommercial-NoDerivs 3.0 Ireland