Clozapine, an atypical antipsychotic agent, has been linked to several cases of acute pancreatitis and hypertriglyceridemia. However, neither acute pancreatitis nor hypertriglyceridemia associated with clozapine has yet been reported in the Republic of Korea. Based on recent experience, we report on a case of severe hypertriglyceridemia and acute pancreatitis associated with clozapine. A 37-year-old schizophrenic woman in good physical condition presented with abdominal pain of acute onset. She had been taking clozapine for 20 months to control her schizophrenia. On admission, her serum triglyceride level was 6,670 mg/dL. Elevated serum amylase and lipase levels, as well as abdominal computed tomography findings, were compatible with acute pancreatitis. After discontinuing the use of clozapine, the serum triglyceride level was normalized and acute pancreatitis resolved.
Youn Joo Jeon, Seung Hwan Lee, Se Na Jang, Eun Sun Kim, Jeong Yo Min, Ji Hyun Kim, Soon Hwa Hong, Jae Hyoung Cho, Hyuk Sang Kwon, Kun Ho Yoon, Bong Yun Cha, Ho Young Son
J Korean Endocr Soc. 2007;22(5):376-380. Published online October 1, 2007
With the broad use of atypical anti-psychotics, altered glucose metabolism has become an item of concern to clinicians and patients. Among the atypical anti-psychotics, clozapine and olanzapine are associated with a relatively high incidence of diabetic ketoacidosis and newly developed diabetes. We report a case of diabetic ketoacidosis in a patient with long-term clozapine therapy. A 35-year-old male with schizophrenia, treated with clozapine for 9 years was admitted into hospital because of comatous mentality. Although never diagnosed with diabetes before, his clinical features were consistent with diabetic ketoacidosis and shock. The patient's serum amylase and lipase levels were elevated and an abdominal computed tomography showed peripancreatic fat infiltration, suggesting the possibility of acute pancreatitis. The patient's serum glucose levels normalized shortly after clozapine treatment. Moreover, the patient ceased all glucose lowering agents upon hospital discharge, and maintained normal blood glucose levels thereafter. As observed in this case, clinicians should carefully screen and monitor blood glucose levels and other clinical parameters in patients treated with atypical anti-psychotics.
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