Diabetic ketoacidosis as a complication of immune checkpoint inhibitor therapy

Background

Diabetic ketoacidosis (DKA) is a rare complication of immune checkpoint inhibitor (ICI) therapy, a treatment used for many malignancies.

Case reports

We present two cases of adults, one without a prior history of diabetes, presenting to the Emergency Department (ED) with DKA induced by ICI therapy.

Why should an emergency physician be aware of this? The emergency physician should be aware of the spectrum of complications associated with ICI therapy, and should remain vigilant in patients presenting with symptoms of DKA and/or unexplained elevated anion gap metabolic acidosis, as DKA in patients without a history of diabetes mellitus can go unrecognized.