title: Quetiapine-induced hypertriglyceridaemia causing acute pancreatitis.
abstract: Second-generation antipsychotics have well-known metabolic side effects such as hyperlipidaemia and hyperglycaemia. A middle-aged man presented with epigastric and flank pain associated with nausea, and was noted to have elevated triglycerides (3590 mg/dL or 40.53 mmol/L), lipase and glucose. Haematological parameters revealed neutropenia with pancytopaenia. The patient was started on conservative management for acute pancreatitis, and on intravenous insulin and oral gemfibrozil for lowering of his triglycerides. He gradually improved and was transitioned to oral atorvastatin and fenofibrate. His triglycerides, glucose and leucocyte counts normalised at discharge and he was transitioned to ziprasidone. The combination of hypertriglyceridaemia, worsening hyperglycaemia and neutropenia made us suspect quetiapine as the causative agent. Medications cause only 0.1-7% of acute pancreatitis cases, with quetiapine implicated in only five-reported cases. Hypertriglyceridaemia (>600 mg/dL or 6.77 mmol/L) is frequently reported with quetiapine use, but severe hypertriglyceridaemia (>1000 mg/dL or 11.29 mmol/L) has been reported in <10 patients.
authors.affiliation: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: John Mark
authors.initials: JM
authors.lastname: Franco
authors.affiliation: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA Division of Hospital Medicine, Department of Internal Medicine, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, USA.
authors.forename: Timothy John
authors.initials: TJ
authors.lastname: Griffin
mesh_terms: D000208:Acute Disease; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy; D006801:Humans; D015228:Hypertriglyceridemia / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000139:chemically induced* / Q000628:therapy; D000069348:Quetiapine Fumarate / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate