+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis



Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis



Endocrinology, Diabetes and Metabolism Case Reports 2018



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/m2). 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. Risperidone-induced diabetic ketoacidosis (DKA) is not synonymous with type 1 diabetes, even in young white patients and may be a manifestation of 'ketosis-prone' type 2 diabetes (KPD).KPD is often only confirmed after the initial presentation, when islet autoimmunity and cautious phasing out of insulin therapy have been assessed, and emergency DKA management remains the same.As in other cases of KPD, a family history of T2DM and presence of cutaneous markers of insulin resistance were important clinical features suggestive of an alternative aetiology for DKA.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 065487549

Download citation: RISBibTeXText

PMID: 29770221

DOI: 10.1530/edm-18-0031


Related references

Risperidone-associated transient diabetic ketoacidosis and diabetes mellitus type 1 in a patient treated with valproate and lithium. Pharmacopsychiatry 38(2): 105-106, 2005

Type 2 diabetes presenting as diabetic ketoacidosis in adolescence. Diabetic Medicine 20(5): 416-417, 2003

Type 1 diabetes mellitus presenting with diabetic ketoacidosis (DKA) in a neonate. Jpma. Journal of the Pakistan Medical Association 66(8): 1026-1028, 2017

Nonimmune fulminant type 1 diabetes presenting with diabetic ketoacidosis during pregnancy. Obstetrics & Gynecology 90(5 Part 2): 877-879, 2002

Nonimmune Fulminant Type 1 Diabetes Presenting With Diabetic Ketoacidosis During Pregnancy. Obstetrics & Gynecology 99(5, Part 2): 877-879, 2002

Diabetic ketoacidosis presenting with pseudonormoglycemia in a 15-year-old girl with type 1 diabetes mellitus. Journal of Clinical Research in Pediatric Endocrinology 5(2): 133-135, 2014

Non-autoimmune fulminant type 1 diabetes mellitus presenting with diabetic ketoacidosis after the delivery. Nihon Naika Gakkai Zasshi. Journal of the Japanese Society of Internal Medicine 92(4): 659-661, 2003

Clinical characteristics and insulin independence of Koreans with new-onset type 2 diabetes presenting with diabetic ketoacidosis. Diabetes/Metabolism Research and Reviews 29(6): 507-513, 2014

Normoglycemic Diabetic Ketoacidosis in a Pregnant Patient with Type II Diabetes Mellitus Presenting for Emergent Cesarean Delivery. A and a Case Reports 6(8): 228-229, 2016

Most type 1 diabetes presenting as diabetic ketoacidosis in Vietnamese people is negative for pancreatic islet cell autoantibodies. Diabetes Research and Clinical Practice 96(3): E63-E65, 2012

Severe Hypertriglyceridemia Causing Pancreatitis in a Child with New-onset Type-I Diabetes Mellitus Presenting with Diabetic Ketoacidosis. Indian Journal of Critical Care Medicine 21(3): 176-178, 2017

Effects of Diabetic Ketoacidosis on Visual and Verbal Neurocognitive Function in Young Patients Presenting with New-Onset Type 1 Diabetes. Journal of Clinical Research in Pediatric Endocrinology 7(3): 203-210, 2016

Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic lung cancer. Journal for ImmunoTherapy of Cancer 5: 40, 2018

Empagliflozin-induced Diabetic Ketoacidosis Unmasking a Type 1 Diabetes Diagnosis. Clinical Practice and Cases in Emergency Medicine 3(2): 140-143, 2019

Sodium-glucose cotransporter 2 inhibitor-associated diabetic ketoacidosis: Report of two cases with hyperglycemic ketoacidosis in type 1 diabetes. Journal of Diabetes 8(1): 165, 2016