Fatal diabetic ketoacidosis and antipsychotic medication

J Forensic Sci. 2013 Mar;58(2):398-403. doi: 10.1111/1556-4029.12044. Epub 2012 Dec 27.


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.

Keywords: antipsychotic medication; atypical antipsychotics; diabetes; fatality; forensic pathology; forensic sciences; ketoacidosis.

MeSH terms

  • 2-Propanol / blood
  • Adult
  • Antipsychotic Agents / adverse effects*
  • Diabetic Ketoacidosis / chemically induced*
  • Diabetic Ketoacidosis / mortality*
  • Female
  • Forensic Toxicology
  • Humans
  • Hyperglycemia / chemically induced
  • Male
  • Mental Disorders / drug therapy
  • Middle Aged
  • Retrospective Studies


  • Antipsychotic Agents
  • 2-Propanol