title: Fatal diabetic ketoacidosis and antipsychotic medication.
abstract: Hyperglycemia and new onset diabetes have been described with certain antipsychotic medications and some of the initial presentations are fatal diabetic ketoacidosis (DKA). We report 17 deaths due to DKA in psychiatric patients treated with second generation antipsychotic medications. Death certificates and toxicology data were searched for DKA and hyperglycemia. We reviewed the medical examiner records which included the autopsy, toxicology, police, and medical examiner investigators' reports. The decedents ranged in age from 32 to 57 years (average 48 years). There were 15 men and two women. The immediate cause of death was DKA in all. The psychiatric disorders included: 10 schizophrenia, three bipolar/schizophrenia, two bipolar, and two major depression. The most frequent atypical antipsychotic medications found were quetiapine and olanzapine followed by risperidone. In 16 deaths, we considered the medication as primary or contributory to the cause of death.
authors.affiliation: New York City Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, 520 First Avenue, New York, NY, 10016.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Ely
authors.forename: Amber R
authors.initials: AR
authors.lastname: Neitzel
authors.forename: James R
authors.initials: JR
authors.lastname: Gill
mesh_terms: D019840:2-Propanol / Q000097:blood; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D016883:Diabetic Ketoacidosis / Q000139:chemically induced* / Q000401:mortality*; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D019840:2-Propanol
keywords: antipsychotic medication; atypical antipsychotics; diabetes; fatality; forensic pathology; forensic sciences; ketoacidosis