A 61-year-old receiving pembrolizumab has polyuria, vomiting and Kussmaul breathing. Glucose is 31 mmol/L, capillary ketones 6.2 mmol/L, venous pH

Question

A 61-year-old receiving pembrolizumab has polyuria, vomiting and Kussmaul breathing. Glucose is 31 mmol/L, capillary ketones 6.2 mmol/L, venous pH 7.16, bicarbonate 10 mmol/L and C-peptide is undetectable. HbA1c was normal before treatment. What is the most appropriate immediate oncology plan?

Accepted Answer

Initiate intravenous DKA therapy, temporarily withhold pembrolizumab and continue long-term insulin

Answer

Initiate intravenous DKA therapy and permanently discontinue all checkpoint inhibition

Answer

Treat with metformin and gliclazide after initial intravenous fluid replacement

Answer

Treat with subcutaneous insulin alone while pembrolizumab continues on schedule

Answer

Initiate intravenous DKA therapy and administer methylprednisolone before later restarting pembrolizumab

irAEs — SCE Medical Oncology MCQ

A 61-year-old receiving pembrolizumab has polyuria, vomiting and Kussmaul breathing. Glucose is 31 mmol/L, capillary ketones 6.2 mmol/L, venous pH 7.16, bicarbonate 10 mmol/L and C-peptide is undetectable. HbA1c was normal before treatment. What is the most appropriate immediate oncology plan?