EUGLYCEMIC DIABETIC KETOACIDOSIS IN AN UNTREATED BREAST CANCER PATIENT WITH SPONTANEOUS TUMOR LYSIS SYNDROME

Abstract

CASE
A 55-year-old Filipino female with diabetes and newly diagnosed breast cancer presented with euglycemic diabetic ketoacidosis after developing spontaneous tumor lysis syndrome (TLS). The patient was recently diagnosed with invasive ductal breast carcinoma. She has uncontrolled T2DM, maintained on insulin glargine, sitagliptin+metformin and dapagliflozin+metformin. She presented with nausea, vomiting, anorexia, epigastric pain, generalized weakness and shortness of breath. She was awake and oriented but tachycardic with Kussmaul breathing. She was clinically dry with no urine output. RBS was 93 mg/dL. ABG revealed metabolic acidosis with ketonemia; hence, she was treated as euglycemic DKA.
Dextrose-containing intravenous fluids together with insulin drip were started. Further workup showed elevated LDH 385 U/L, hypocalcemia 1.11 mmol/L, hyperphosphatemia 22.7 mg/dL, hyperuricemia 18.5 mg/dL, hyperkalemia 6.2 mmol/L, elevated creatinine 13.10 mg/dL. Acute kidney injury secondary to TLS was considered; hence, combined daily sessions of hemodialysis/hemoperfusion were started. Repeat laboratory examinations showed significant improvement after the third session. Euglycemic DKA resolved after 24 hours. She was later offered anti-HER2- positive chemotherapy.