| Abstrakt: |
INTRODUCTION/OBJECTIVES: Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus (DM) and is characterized by hyperglycemia, hyperketonemia and metabolic acidosis. With the increasing use of immune checkpoint inhibitors (ICIs), such as pembrolizumab in cancer therapy, it’s important to understand immune-related adverse events that comes with it. CASE PRESENTATION: A 63–year–old female patient with no previous history of diabetes was admitted to endocrinology department due to new-onset DM representing with DKA. She presented with nausea and vomiting, while she started to experience polyuria and polydipsia, along with some suprapubical abdominal pain two weeks prior to admission. In June 2021 she was diagnosed with a sigmoid colon adenocarcinoma which was treated surgically. In February 2022 PET CT revealed liver metastases and metastasectomy was performed. Patient relapsed and in December 2022, a month before admission, she started treatment with FOLFIRI in combination with pembrolizumab. On the day of admission laboratory findings showed blood glucose level 56.8 mmol/L, urine positive for ketones, proteins, glucose and blood, and arterial blood pH of 7.125 and bicarbonates 7.4 mmol/L. Immediately after admission, intravenous fluids and insulin administration were started, along with potassium replacement, pantoprazole and metoclopramide. After DKA was resolved, subcutaneous insulin therapy was introduced and patient underwent education on diabetes management. CONCLUSION: Development of DM and DKA, as well as difficulty achieving good glycemic control can be associated with current pembrolizumab therapy. Regular blood glucose monitoring during ICIs treatment has the potential of preventing development of acute diabetic complications. [ABSTRACT FROM AUTHOR] |
