Endocrine Abstracts

The triad of hypertriglyceridemia-induced acute pancreatitis with concurrent diabetic ketoacidosis (DKA) is rare in previously undiagnosed diabetic patients. Drug-induced diabetesis one of the main adverse effects of Risperidone, a second generation (atypical) class of antipsychotic used in the treatment of schizophrenia and bipolar disorder, however, Risperidone-induced diabetic ketoacidosis is rare. We are reporting a case of diabetic ketoacidosis associated with hypertriglyceridemia- induced acute pancreatitis as the first presentation of Risperidone-induced diabetes

Case: A 29 years old Pakistani male with a background diagnosis of schizoaffective disorder presented to the Emergency Department with nausea, vomiting and abdominal pain three weeks after starting Risperidone treatment. He reported a history of polyurea and polydipsia few days after initiation of Risperidone treatment. Examination showed obese male with evidence of dehydration and abdominal tenderness. Laboratory investigations revealed marked hyperglycemia with blood glucose level of 583 mg /dl and high anion gap metabolic acidosis. It also showed evidence of acute pancreatitis with serum lipase more than 15 000 U/l (Normal range 73–393) associated with severe hypertriglyceridemia with triglyceride level more than 2000 mg/dl (Normal range less than 150). He was managed with intravenous insulin infusion and hydration as per diabetic ketoacidosis protocol. He responded slowly and required high doses of insulin to correct his hyperglycemia, metabolic acidosis and hyperglyceridemia. Acute pancreatitis responded well to conservative measures. The patient was discharged on subcutaneous insulin therapy along with oral fenofibrates.

Conclusion: Risperidone induced diabetic ketoacidosis with concurrent hypertriglyceridemia-induced acute pancreatitis is rare. Prompt recognition of the coexistence of these three entities is crucial for adequate management.