Fatal hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine

BMJ Case Rep. 2014 Jan 8:2014:bcr2013202039. doi: 10.1136/bcr-2013-202039.


A 27-year-old man treated with quetiapine for anxiety disorder developed hypertriglyceridaemia-induced acute pancreatitis and diabetic ketoacidosis. He was otherwise physically healthy with no family history of hyperlipidaemia. Despite aggressive intensive therapy he died of multiorgan failure within 36 h from initial presentation. While second-generation antipsychotics are well known to be causally linked to diabetes and hyperlipidaemia, this is to my knowledge the first-described case of a fatal triad of extreme hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine. Clinicians should be aware of this rare clinical presentation since rapid progression to multiorgan failure can occur. Early supportive therapy should be initiated. Lactescent serum and ketoacidosis in severe acute pancreatitis should not be overlooked-initiate insulin therapy and possibly plasmapheresis in case of extreme hypertriglyceridaemia.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use*
  • Anxiety Disorders / drug therapy*
  • Delayed Diagnosis
  • Diabetic Ketoacidosis / chemically induced*
  • Diabetic Ketoacidosis / diagnosis
  • Diagnosis, Differential
  • Dibenzothiazepines / adverse effects*
  • Dibenzothiazepines / therapeutic use*
  • Dose-Response Relationship, Drug
  • Fatal Outcome
  • Humans
  • Hypertriglyceridemia / chemically induced*
  • Hypertriglyceridemia / diagnosis
  • Male
  • Pancreas / pathology
  • Pancreatitis, Acute Necrotizing / chemically induced*
  • Pancreatitis, Acute Necrotizing / diagnosis
  • Phobic Disorders / drug therapy*
  • Psychotic Disorders / drug therapy*
  • Quetiapine Fumarate
  • Tomography, X-Ray Computed


  • Antipsychotic Agents
  • Dibenzothiazepines
  • Quetiapine Fumarate