ABSTRACT:
Background & Objective: Clozapine remains the benchmark atypical antipsychotic for treatment-resistant schizophrenia; however, its administration is associated with significant metabolic liabilities, including altered glucose homeostasis and new-onset diabetes mellitus. This case report evaluates a 31-year-old male with Schizophrenia, continuous (ICD-11: 6A20.20), maintained on outpatient Clozapine 50 mg/day for 6 months, who was admitted for an acute exacerbation of severe negative symptoms and psychomotor retardation. Upon inpatient admission and before dose titration, baseline biochemical screening revealed an elevated Random Blood Sugar (RBS) of 156.00 mg/dL in a non-diabetic, markedly underweight patient (Body Mass Index: 16.6 kg/m²). Subsequent dose escalation to 100 mg/day over three days produced clinical psychopathology improvement without acute osmotic symptoms. This report highlights the clinical imperative of mandatory baseline metabolic profiling before psychotropic dose adjustments, early blood glucose surveillance, and systematic post-discharge follow-up, emphasising that dysglycaemia can emerge independently of high BMI or adiposity.