Olanzapine에 의해 당뇨병성 케톤산증으로 진행한 환자 1예
A Case of Diabetic Ketoacidosis by Olanzapine
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초록
저자들은 4년 동안 2회에 걸쳐서 olanzapine 유지 치료를 받던 중, 당뇨병이 2회 발생 혹은 악화되었으며, 두 번째 당뇨병 악화 시에는 당뇨병성 케톤산증과 섬망 상태까지 진행한 47세 남자 환자를 성공적으로 치료하였다. 환자는 최초 olanzapine 투여 이후 3개월 만에 14kg의 체중 증가를 경험하고, 3년 만에 당뇨병이 발생하였다. 이후 우연한 기회에 risperidone으로 교체하면서 당뇨병이 호전되었으나, 2개월 후 다시 olanzapine을 투여 받기 시작하면서 6개월 만에 15kg의 체중 증가를 보여주었고, 투약 재개 1년 만에 심각한 상태의 당뇨병성 케톤산증에 빠졌다. 저자들은 당뇨병의 경과에 바람직하지 못한 영향을 미쳤다고 판단되는 olanzapine을 amisupride로 투약 교체하였고, 이후 약 30여 일째에 환자는 모든 당뇨 관련 약제를 더 이상 필요로 하지 않을 정도의 상태로 회복되었으며 정신과적인 증상 역시 잘 조절된 상태를 유지하였다. 이후 1년 간의 추적 관찰 동안 당뇨병과 정신병적 증상의 악화는 없었고, 체중 역시 68kg로 퇴원 전의 상태를 유지하였다. 이에 저자들은 olanzapine이 환자의 당뇨병의 발생과 경과에 중대한 영향을 미친 것으로 보이는 사례인 것으로 판단하고, 환자의 병력과 더불어 관련 문헌에 대한 고찰을 덧붙여 증례 보고하고자 한다.
Abstract
We successfully treated a 47 year old male patient who developed diabetes twice and later fell in diabetic ketoacidosis and delirium during the 4 years of olanzapine therapy. For the first 3 months of olanzapine medication the patient gained 14kg and developed diabetes mellitus 3 years later in the maintenance of olanzapine. Fortunately his diabetes was improved after switching his medication to risperidone. 2 months later he remedicated olanzapine by chance and got 15kg of weight gain. In a year he developed diabetes again and was finally transferred to emergency room due to diabetic ketoacidosis. It was thought that olanzapine played a negative role in the course of patient’s diabetes, and it was switched to amisulpride. The result was that blood glucose levels began to be well controlled without any antihyperglycemic agents in 30 days after the complete withdrawal of olanzapine. During a year’s follow up after discharge, the patient didn’t show any aggravation of psychotic symptoms and any signs of diabetes. He kept his body weight 68kg which was the same weight when he was discharged from the hospital. This case showed clearly how olanzapine affected the onset and the course of diabetes in a schizophrenic patient. Therefore we report this case with a few olanzapine related considerations.
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