Madsen Kristian Roerbaek
Multidisciplinary Intensive Care, Odense University Hospital, Odense, Denmark.
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.
一名27岁患有焦虑症的男性，在接受喹硫平治疗后出现了高甘油三酯血症诱发的急性胰腺炎和糖尿病酮症酸中毒。他在其他方面身体健康，无高脂血症家族史。尽管进行了积极的强化治疗，但他在首次就诊后36小时内死于多器官功能衰竭。虽然第二代抗精神病药物与糖尿病和高脂血症之间的因果关系已广为人知，但据我所知，这是首例描述为由喹硫平可能诱发的极端高甘油三酯血症、急性胰腺炎和糖尿病酮症酸中毒致死三联征的病例。临床医生应意识到这种罕见的临床表现，因为可能会迅速进展为多器官功能衰竭。应尽早开始支持性治疗。严重急性胰腺炎时出现的乳糜状血清和酮症酸中毒不应被忽视——在出现极端高甘油三酯血症的情况下应启动胰岛素治疗，并可能进行血浆置换。
