Franco John Mark, Vallabhajosyula Saraschandra, Griffin Timothy John
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
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.
BMJ Case Rep. 2015 May 14;2015:bcr2015209571. doi: 10.1136/bcr-2015-209571.
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.
第二代抗精神病药物有诸如高脂血症和高血糖症等众所周知的代谢副作用。一名中年男性出现上腹部和侧腹疼痛并伴有恶心，检查发现甘油三酯（3590 mg/dL或40.53 mmol/L）、脂肪酶和血糖升高。血液学参数显示中性粒细胞减少伴全血细胞减少。该患者开始接受急性胰腺炎的保守治疗，并使用静脉胰岛素和口服吉非贝齐来降低甘油三酯水平。他逐渐好转，并过渡到口服阿托伐他汀和非诺贝特。出院时他的甘油三酯、血糖和白细胞计数恢复正常，并改用齐拉西酮。高甘油三酯血症、血糖恶化和中性粒细胞减少的综合情况使我们怀疑喹硫平是致病因素。药物仅导致0.1 - 7%的急性胰腺炎病例，喹硫平仅涉及五例报告病例。使用喹硫平经常会报告高甘油三酯血症（>600 mg/dL或6.77 mmol/L），但严重高甘油三酯血症（>1000 mg/dL或11.29 mmol/L）在不到10名患者中被报告过。
