Ketoacidotic diabetic coma with ziprasidone (ZELDOX): A 64-year-old woman who had already been hospitalised several times for delusional depression and anxiety developed ketoacidotic coma in connection with new-onset, presumably drug-induced diabetes mellitus while on lithium (LITHIUM APOGEPHA), mirtazapine (REMERGIL), and about four weeks after starting on ziprasidone (ZELDOX). An intensification of insulin therapy was necessary after the acute treatment phase despite of halving the ziprasidone dose. Metabolism normalised not until the "atypical" antipsychotic was completely withdrawn (NETZWERK report 13.776). Hyperglycaemia and new-onset diabetes mellitus are known adverse effects of "atypical" antipsychotics. There have also been reports on ziprasidone-associated hyperglycaemia and diabetes mellitus (Pfizer, Dear Healthcare Practitioner Letter, Aug. 2004). In the FDA MedWatch surveillance program the proportion of adverse reaction reports on diabetes mellitus manifests as ketoacidosis in association with the "atypical" antipsychotics olanzapine (ZYPREXA) and clozapine (LEPONEX inter alia), which have been on the market for a relatively long time, is alarmingly high, at 43% (clozapine) and 48% (olanzapine). Ketoacidosis is also reported in 28% of cases of new-onset hyperglycaemia in patients receiving risperidone (RISPERDAL). An early onset of the adverse reaction is typical: Half of the cases of new-onset diabetes with clozapine, olanzapine and risperidone start within the first three months of therapy. 6.5% of patients (25 out of 384) with hyperglycaemia as an adverse reaction died on clozapine, 6.3% (15 out of 237) on olanzapine and 3% (4 out of 131) on risperidone (KOLLER, E. et al.: Am. J. Med. 2001; 111: 716-23; KOLLER, E.A. et al.: Pharmacotherapy 2002; 22: 841-52; KOLLER, E.A. et al.: Pharmacotherapy 2003; 23: 735-44).