Rapid-onset diabetic ketoacidosis secondary to nivolumab therapy. (27th April 2018)

• Record Type: Journal Article
• Authors: Lee, Senhong; Morgan, Aparna; Shah, Sonali; Ebeling, Peter R
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2018)
• Publication Date: 2018-04-27
• Subjects: Adult -- Male -- White -- Australia; Pancreas -- Diabetes -- Insulin -- Thyroxine (T4) -- TSH -- Diabetic ketoacidosis -- Iatrogenic disorder -- Diabetes mellitus type 2 -- Autoimmune disorders -- Hyperthyroidism -- Thyroiditis -- Hyperglycaemia; Diabetic ketoacidosis -- Diabetes mellitus type 2 -- Hyperthyroidism -- Hyperglycaemia -- Coughing -- Metabolic acidosis -- Polyuria -- Polydipsia -- Fatigue -- Seizures -- Glucose (blood) -- Haemoglobin A1c -- C-peptide (blood) -- GADA -- CT scan -- Ketones (plasma) -- Biopsy -- Bicarbonate -- Anion gap -- FT4 -- TSH -- Fluid repletion -- Chemotherapy -- Nivolumab -- Empagliflozin -- SGLT2 inhibitors -- Insulin -- Carboplatin -- Paclitaxel -- Metformin -- Sitagliptin -- DPP4 inhibitors; Oncology; Unique/unexpected symptoms or presentations of a disease -- April -- 2018; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-18-0021
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: We report a case of a 67-year-old man with type 2 diabetes presented with diabetic ketoacidosis, two weeks after his first dose of nivolumab therapy for non–small-cell lung carcinoma. He was started on empagliflozin two days prior in the setting of hyperglycaemia after the initiation of nivolumab therapy. Laboratory evaluation revealed an undetectable C-peptide and a positive anti-glutamic acid decarboxylase (GAD) antibody. He was treated with intravenous fluids and insulin infusion and was subsequently transitioned to subcutaneous insulin and discharged home. He subsequently has developed likely autoimmune thyroiditis and autoimmune encephalitis. Learning points: Glycemic surveillance in patients receiving immune checkpoint inhibitors is recommended. Early glycemic surveillance after commencement of anti-programmed cell death-1 (PD-1) inhibitors may be indicated in selected populations, including patients with underlying type 2 diabetes mellitus and positive anti-glutamic acid decarboxylase (GAD) antibody. Sodium-glucose co transporter-2 (SGLT2) inhibitors should be used with caution in patients on immunotherapy.