This case, like most of the other 24 reported cases of fatal ketoacidosis associated with olanzapine, progressed to death within a relatively short time. Recently, Wilson et al. (3) reported five additional patients with nonfatal ketoacidosis, two of whom were taking olanzapine, two clozapine (augmented with risperidone in one case), and one quetiapine, thus raising the issue of whether ketoacidosis is also associated with other second-generation antipsychotics or combinations of medications. Alternatively, ketoacidosis may occur in genetically predisposed individuals, such as those with the polymorphism recently described as being associated with clozapine-induced weight gain (4). The fact that African Americans were disproportionately represented in previous reports (1, 3, 5) and an African American was involved in this case is consistent with that hypothesis.