M. Eskildsen 1 , K. Lasser 1 ; 1 Cambridge Hospital, Cambridge, MA (Tracking ID #74000) LEARNING OBJECTIVES: 1. To recognize the common side effects of atypical antipsychotics. 2. To learn about a previously unreported complication of these drugs. CASE INFORMATION: A 39-year-old man with a history of hepatitis C, schizophrenia, and past alcohol abuse was admitted with worsening abdominal pain and distension over one month, accompanied by vomiting and watery diarrhea. He stated that he had been sober for two years. His only medications were risperidone at 8 mg daily, and olanzapine at 10 mg daily. His psychiatrist had decreased the olanzapine dosage and attempted to discontinue his prescription one year prior to admission due to poor response, but the patient had refused to do so for unclear reasons. Physical exam revealed a temperature of 37.8C; and a distended, diffusely tender abdomen, without signs of ascites or peritoneal irritation. Laboratory evaluation was remarkable for triglycerides that were over 3800 mg/dl, our lab's upper limit of measurement, and a lipase of 250 U/l. Serum glucose was 553 mg/dl, with no prior readings in the diabetic range. A computed tomography of the abdomen indicated mild pancreatitis with no biliary obstruction. On admission, after discontinuing both medications, we gave him intravenous fluids and nothing by mouth, as well as patient-controlled analgesia with intravenous morphine. Upon discharge, one week later, he was pain-free, and his triglycerides and glucose decreased to 308 and 250 mg/dl, respectively. Of his antipsychotics, risperidone alone was resumed before discharge, up to a dose of 8 mg daily two months later. He has remained without abdominal pain, with serum triglycerides in the 300 range, and persistent diabetes mellitus treated with metformin. IMPLICATIONS/DISCUSSION: A MEDLINE search yielded two reports of pancreatitis associated with olanzapine, and two with risperidone. Hyperlipidemia, including elevated triglycerides, is a side effect of both drugs, although it is more commonly observed with olanzapine. However, this is the first described case of pancreatitis in relation to either of these two drugs that has been associated with massive hypertriglyceridemia, and we have reported it as an adverse event to the FDA. Because he has tolerated risperidone well after discharge, olanzapine seems more likely to have precipitated his pancreatitis, although a synergistic mechanism between the two drugs is another possibility. This case illustrates the need for close monitoring of lipids and glucose in patients taking atypical antipsychotics. 