Aggravation of Hypertriglyceridemia and Acute Pancreatitis in a Bipolar Patient Treated with Quetiapine
A 51-year-old woman with a history of bipolar affective disorder was presented to our hospital with an 8-h history of nausea and epigastric pain radiating caudally. Three months prior to admission, an elevated serum triglyceride level (408 mg/dL) was noted, but the patient didn't receive any lipid-lowering agents. Two months before presentation, she was treated for bipolar effective disorder with valproic acid 500 mg twice daily, quetiapine 600 mg at bedtime, and flurazepam 30 mg at bedtime. One month prior to admission, valproic acid was tapered and stopped, and quetiapine dose had been increased to 800 mg at bedtime. At current presentation, she was taking both quetiapine 800 mg and flurazepam 30 mg at bedtime. There was no history of alcohol abuse, recent abdominal trauma or surgery, preceding viral syndromes, or cholelithiasis, and no other concomitant medications were being used.\nThe initial physical examination indicated a diffuse abdominal tenderness without muscle guarding or rebound tenderness, and hypoactive bowel sounds were auscultated. Laboratory studies showed a leukocyte count of 9.9×109/L, with a differential count of 68% neutrophils and 24% lymphocytes. Serum electrolytes and liver function tests were within normal limits. Other pertinent laboratory values included a serum amylase of 352 IU/L (normal, 30-110 IU/L), serum lipase of 1210 IU/L (normal, 23-300 IU/L), triglyceride of 1508 mg/dL (normal, 35-150 mg/dL), and a total cholesterol level of 450 mg/dL (normal, 130-200 mg/dL). Abdominal ultrasound showed no evidence of gallbladder disease or dilatation of the bile ducts. Abdominal computed tomography showed a blurring contour from pancreatic head to tail, with minimal fluid collection at the pancreatic head region. A diagnosis of acute pancreatitis was made.\nThen the patient was treated symptomatically with volume repletion and meperidine for pain relief. Quetiapine was suspected as the cause of severe hypertriglyceridemia, and was immediately withdrawn. In addition, treatment with oral fenofibrate 160 mg daily was commenced for reducing serum triglycerides. Ten days later, the patient was free of abdominal pain, the serum amylase and lipase values were normal, and the triglyceride level was reduced to 337 mg/dL. The patient was discharged on the following medications: aripiprazole 5 mg at bedtime, flurazepam 60 mg at bedtime, and fenofibrate 160 mg once daily. The patient was discharged with appointments for follow-up with the endocrinology and psychiatry services. She was asymptomatic at the 3-month follow-up.