Rare Case Highlights Dual Risk of Hypertriglyceridemia-Induced Pancreatitis and DKA With Olanzapine
USA: A recent case report published in Clinical Case Reports by Sushrut Ingawale from Quinnipiac University Frank H. Netter MD School of Medicine, and Hartford HealthCare/St. Vincent's Medical Center, Connecticut, highlights a rare but serious combination of metabolic complications associated with olanzapine use. The report describes the concurrent occurrence of hypertriglyceridemia-induced acute pancreatitis and diabetic ketoacidosis (DKA), emphasizing the need for heightened clinical vigilance.
Acute pancreatitis linked to antipsychotic medications is uncommon, and when triggered by severe hypertriglyceridemia, it can become life-threatening. The simultaneous presence of DKA further complicates the clinical picture, making early recognition and intervention critical.
The case involved a 43-year-old man with bipolar disorder who had been receiving olanzapine therapy for approximately 2.5 months. His medical history included type 2 diabetes mellitus, hyperlipidemia, and prior substance use, though he had remained abstinent for several months. He presented to the emergency department with generalized body aches and back pain, without typical gastrointestinal symptoms such as nausea or vomiting.
On examination, the patient was obese and exhibited signs of dehydration, with mild tenderness in the epigastric region. Laboratory findings revealed severe metabolic abnormalities, including a markedly elevated blood glucose level of 501 mg/dL, high anion gap metabolic acidosis, and significant ketonemia, confirming DKA. In addition, his triglyceride levels were critically elevated, exceeding 5600 mg/dL, along with deranged cholesterol parameters. Imaging studies supported the diagnosis of acute pancreatitis, showing pancreatic inflammation without evidence of necrosis or gallstones.
After ruling out more common causes of pancreatitis such as alcohol use and gallstone disease, olanzapine was identified as the most probable trigger. The drug was immediately discontinued, and the patient was managed in the intensive care unit with aggressive supportive therapy. Treatment included intravenous fluids, insulin infusion to address both hyperglycemia and hypertriglyceridemia, bowel rest, and pain control.
The patient responded well to treatment, with triglyceride levels declining significantly within days and no development of complications such as pancreatic necrosis or organ failure. He was discharged in stable condition, and follow-up evaluations confirmed full clinical recovery without long-term sequelae.
The case highlights the potential for olanzapine to induce severe metabolic disturbances, even after a relatively short duration of use. It highlights the importance of baseline risk assessment and ongoing monitoring of metabolic parameters, particularly blood glucose and lipid levels, in patients prescribed antipsychotic medications.
The authors emphasize that clinicians should remain alert to atypical presentations and consider medication-induced causes when evaluating metabolic emergencies. Early diagnosis, prompt discontinuation of the offending agent, and multidisciplinary management are essential to prevent serious complications.
Reference:
Ingawale, S., Pandey, A., Varak, P., Miskin, V., Chandak, V., & Sharma, P. (2026). Concomitant Hypertriglyceridemia-Induced Pancreatitis and Diabetic Ketoacidosis in the Setting of Olanzapine Use: A Case Report. Clinical Case Reports, 14(4), e72501. https://doi.org/10.1002/ccr3.72501
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