FRI662 Quetiapine Induced Severe Hypoglycemia In Elderly Patients Without Diabetes

Disclosure: T. gusov: None. A. Akofu: None. F. marium: None. S. Dejhansathit: None. M.J. Gardner: None. N. Sheung: None. A. Uddin: None. N. Akabogu: None. Introduction: Quetiapine is a second-generation antipsychotic (SGA) commonly used for a wide range of psychotic and mood disorders, sleep aid and others. Older individuals are often treated with quetiapine to relieve psychotic symptoms associated with conditions including dementia and delirium. Common metabolic side effects include weight gain, hyperglycemia, dyslipidemia, and diabetes mellitus. There are few reports of mild asymptomatic hypoglycemia in individuals without diabetes. Hypoglycemia is a serious medical condition with high morbidity and mortality. We report an older individual without diabetes who developed severe hypoglycemia from treatment with quetiapine. Clinical case: 84 years old female was admitted to the hospital for altered mentation, right sided weakness. Cerebral vascular accident was ruled out with imaging studies. The patient was found to be hypoglycemic at 64 mg/dl. Treated with IV D5 with effect, hypoglycemia recurred and was persistent, IV treatment with glucose was initiated. Laboratory results: glucose 46 mg/dL, C- peptide 0.361nmol/L, insulin 1.21 mcunit/ml, proinsulin 6.1 pmol/L, sulfonylurea negative, beta hydroxybutyrate 0.97mmol/L, insulin Ab negative, Administration of 1 mg of glucagon increased blood glucose by 20 mg/dl. Cosyntropin test was normal, TSH and thyroxine levels are normal. Abdominal US ruled out obvious liver and pancreatic pathology. Medication list reviewed. Quetiapine was suspected as the cause and was stopped. Within the next 24 hours blood glucose normalized, IV glucose treatment stopped. She was observed for 2 more days, had no recurrent episodes and was discharged. Conclusion: Quetiapine is widely used to relieve psychotic symptoms and sleep aid. MEdication is usually associated with hyperglycemia. In the present case we report quetiapine-induced hypoglycemia in the patient without diabetes, which was more severe than that described in previous reports, and required dextrose fluid infusion. Quetiapine may increase the amount of basal insulin secreted by pancreatic β-cells and thereby cause hypoglycemia. Since quetiapine is used for the relief of psychotic symptoms, it is crucial to understand the potential adverse effects related to the use of this medication, and to observe any symptoms that may appear. We suggest that clinicians should carefully observe older patients receiving quetiapine to identify any hypoglycemic symptoms that may appear. Reference: Quetiapine-Induced Severe Hypoglycemia in the patient without Diabetes Mellitus: A Case Report Suk Ju Cho, Sang Ah Lee. Annals of Geriatric Medicine and Research 2019;23(1):35-37 Presentation: Friday, June 16, 2023