Dr. Tang presents a 70 yo gentleman with PMH significant for SCLC with new onset DKA in the setting of atezolizumab (immune checkpoint inhibitor).
Teaching points:
1. What are the diagnostic criteria for DKA vs. HHS?
Often, Beta-hydroxybutyrate is present in DKA; however the level does not correlate with the severity of DKA
Acetone and Acetoacetate are other breakdown products of ketogenesis and are not as frequently measured
2. Management strategies for DKA:
Correct hypovolemia and hyperosmolality
Correct/replete potassium prior to starting insulin (IF K<3.3, need to replete K before starting insulin therapy).
Give IV insulin to halt ketogenesis
3. Checkpoint inhibitor-induced Diabetes:
These new immunotherapies target receptor:ligand pairs and modulate T-cell activity
They are highly associated with development of autoimmune diseases
Important to check A1C prior to and during treatment with immune checkpoint inhibitors
Most common presentation with checkpoint-inhibitor-induced autoimmune diabetes presents with DKA
4. What are some potential paraneoplastic syndromes associated with SCLC?
Hypercalcemia secondary to bony mets or tumor secretion of PTHrP, calcitriol or other cytokines --> anorexia, nausea, vomiting, constipation, lethargy, polyuria, polydipsia, dehydration
SiADH secretion: frequently caused by SCLC and results in hyponatremia --> anorexia, nausea, vomiting, cerebral edema
Neurologic syndromes: Lambert-Eaton myasthenic sydrome, cerebellar ataxia, sensory neuropathy, limbic encephalitis, encephalomyelitis, autonomic neuropathy, retinopathy, opsomyoclonus
Comments