New-onset type II diabetes mellitus, hyperosmolar non-ketotic coma, rhabdomyolysis and acute renal failure in a patient treated with sulpiride.

New-onset type II diabetes mellitus, hyperosmolar non-ketotic coma, rhabdomyolysis and acute renal failure in a patient treated with sulpiride Sir, Various drugs have been reported to cause myoglobinuric acute renal failure [1–4]. In this report, we present a case of oral sulpiride administration, complicated with new-onset type II diabetes mellitus, hyperosmolar non-ketotic coma, rhabdomyolysis and acute renal failure. Case. A 44-year-old female patient consulted a psychiatrist for her complaints of anxiety and hallucination. At the time, her laboratory results were normal. Oral sulpiride had been administered at a dose of 200 mg per day and increased to 600 mg/day gradually. At admission to our hospital 3 days later, she was unconscious. On physical examination, her blood pressure was 90/60 mmHg and her temperature was 38.5 C; turgor-tonus was diminished and muscle rigidity was present. Abnormal laboratory analyses were as follows: white blood cell count 17 Â 10 3 /ml, serum glucose 389 mg/dl, blood urea nitrogen 76 mg/dl, serum creatinine 5.0 mg/dl, sodium 168 mmol/l, calcium 7.8 mg/dl, creatine phos-phokinase 7070 U/l, aspartate transaminase 151 U/l, alanine transaminase 52 U/l, lactate dehydrogenase 654 U/l and blood osmolality 360 mosm/kg H 2 O. Her serum myoglobin level was 4360 ng/ml (normal range: 7–64) and her urinary myoglobin level was 7620 ng/ml (normal range: 0–200). Serum islet cell antibody and glutamic acid decarboxylase antibodies were negative. Insulin and C-peptide were increased after the intravenous administration of 1 mg of glucagon. HbA1c was normal (5.0%). Urinary dipstick analysis was 2þ positive for glucose, 1þ positive for protein, negative for ketone and 3þ positive in the haem test. Urinary sediment showed a few red blood cells and 2–3 leukocytes per high-power field. No microbial agent was grown in cultures. Renal ultrasonography and electromyography (EMG) examination were normal. Sulpiride was withdrawn. She was treated with bicarbonate and intensive insulin. On the 12th day, her mental status, fever and laboratory analysis returned to normal (figure 1). On psychiatric evaluation, a brief psychotic disorder was diagnosed. One month after discharge, all laboratory analyses remained normal and the patient had no complaints. Discussion. Sulpiride is a selective dopamine D2 antagonist with antipsychotic and antidepressant activity [5]. Sulpiride has been associated with many side effects [5–7]. Only one case of neuroleptic malignant syndrome with myoglobinuric acute renal failure after withdrawal of sulpiride and mapro-tiline therapy was described in the literature [2]. However, in this case, new-onset diabetes mellitus and …