Quetiapine Leads to Hyperosmolar Hyperglycemic State in a Nonagenarian

Megan Cheslock, MD

Ronald T Garry MD, FACP, AGSF

Jonathan T Stewart, MD, AGSF

Keywords

antipsychotic

behavioral and psychological symptoms of dementia

Abstract

Behavioral and psychological symptoms of dementia (BPSD) are present in the vast majority of patients with dementia. Quetiapine, a second-generation antipsychotic used off-label for BPSD, has been associated with adverse metabolic effects in older adults. Despite this, there are no specific guidelines on monitoring serum glucose or lipids after initiation of antipsychotics. We describe a case of hyperosmolar hyperglycemic state (HHS) likely precipitated by quetiapine in an older adult with BPSD. In this patient without a prior history of diabetes, quetiapine likely led to increased insulin resistance and subsequent HHS. Infection and acute ischemia, which commonly precipitate HHS, were absent. This patient had risk factors for diabetes, including a previously elevated random blood glucose level and obesity. Review of encounters preceding hospitalization revealed no symptoms to suggest poorly controlled diabetes. Quetiapine and other antipsychotics associated with metabolic syndrome should be used cautiously in older adults. Routine glucose monitoring is important.

Citation: Ann Longterm Care. 2022.
DOI: 10.25270/altc.2022.03.002
Received September 22, 2020; accepted January 28, 2021.
Published online March 24, 2022.

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Affiliations, Disclosures, & Correspondence