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Small-intestinal necrosis due to non-occlusive mesenteric ischemia with diabetic ketoacidosis after quetiapine treatment

  • Yoshito Itoh
  • Ryo Sagawa
  • Hirotaka Kinoshita
  • Sachiko Tamba
  • Koji Yamamoto
  • Yuya Yamada
  • Yuji Matsuzawa
Case Report
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Abstract

We report a 66-year-old male who developed diabetic ketoacidosis (DKA) and necrosis of the small intestine due to non-occlusive mesenteric ischemia (NOMI), 3 months after starting quetiapine treatment. He was transferred to our hospital and diagnosed as diabetic for the first time, associated with DKA. Despite improvement in DKA, abdominal pain worsened gradually 10 h after hospitalization. Computed tomography (CT) revealed bowel emphysema, and gas out of the gut wall, in the mesenteric veins and the intrahepatic portal vein, suggesting intestinal necrosis. He survived because of resection of necrotic small-intestinal tissue and he finally required no diabetes treatment. Mesenteric arteries were patent with good palpitation without occlusion or thrombosis, and pathological findings showed ischemic enteritis, which is consistent with NOMI. DKA is a rare but serious side effect of second-generation antipsychotic medications (SGAMs) such as quetiapine, which can result in NOMI: a life-threatening complication. We must keep in mind that the plasma glucose concentration may increase in patients taking SGAMs, or that NOMI may occur concurrently if DKA develops.

Keywords

Non-occlusive mesenteric ischemia (NOMI) Diabetic ketoacidosis (DKA) Second-generation antipsychotic medications (SGAMs) Quetiapine 

Notes

Compliance with ethical standards

Conflict of interest

The authors state that they have no conflict of interest (COI).

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained for the publication of the case report.

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Copyright information

© The Japan Diabetes Society 2018

Authors and Affiliations

  1. 1.Departments of Endocrinology and MetabolismSumitomo HospitalOsakaJapan
  2. 2.General MedicineSumitomo HospitalOsakaJapan

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