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• W4387245859 abstract "SESSION TITLE: Critical Care Case Report Posters 22 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) that accounts for approximately greater than 140,000 hospitalizations per year, often necessitating a critical care setting (1). Common precipitating factors include infection, medication non-compliance, drug use, and pregnancy. It is rare to see an association between specific pharmacological agents causing DM leading to DKA. We report a rare case of DKA as a complication of Alpelisib, a phosphoinositide 3-kinase inhibitor approved for metastatic breast cancer. CASE PRESENTATION: A 52-year-old female with a past medical history of stage 4 metastatic breast carcinoma (diagnosed in 2006) with a recurrence of disease in the lung in 2015, Type II DM presents with one day of generalized weakness, diarrhea, and dizziness. In 2006, her breast cancer was treated with mastectomy, docetaxel, doxorubicin, and cyclophosphamide, followed by radiation therapy, followed by tamoxifen+goserelin. In 2015, she was found to have lung metastases, treated with letrozole and palbociclib. A PET/CT in late 2022 demonstrated disease progression at the pleura and right cardiac border, with an SUV max of 4.2 and a liquid biopsy significant for PIK3CA mutation. She started tamoxifen and Alpelisib for progression of disease. Prior to starting this regimen, her serum glucose and A1c levels were within normal limits. One month after beginning Alpelisib, she developed Type II DM with an HgbA1c of 7.3%. Her home medications for diabetes included empagliflozin and metformin, reducing her A1c to 6.8% on admission. During this presentation, she was hypotensive, with a serum glucose of 314, anion gap of 22 with a pH of 7.2, serum bicarbonate of 12 mmol/L, beta-hydroxybutyrate of 6 mmol/L, urinary ketones of 80 mg/dL. She was diagnosed with DKA and admitted to the ICU for further management, responding well to the standard of care. Alpelisib was discontinued and was transitioned to an alternative regimen. DISCUSSION: Alpelisib is a PI3k inhibitor that has demonstrated efficacy in metastatic breast cancer following the progression of disease after an endocrine-based regimen. Hyperglycemia is a common side effect of Alpelisib, therefore glucose is monitored before initiating therapy. Hyperglycemia is reported in 65% of patients treated with Alpelisib (2). According to the drug manufacturer Novartis website, ketoacidosis has only been reported in 2 patients (3). This unique case highlights an uncommon underlying cause of DKA, in a patient with controlled DM. This patient's disease course, unfortunately, has been very complex. Although her previous therapies may have the propensity to cause DM, the temporal relationship of starting Aleplisib to her development of DM and DKA necessitates prudence. Treatment of DKA requires early intervention and reversal of hyperglycemia. However, elucidating and addressing the precipitating cause should not be delayed. CONCLUSIONS: This case emphasizes the importance of recognizing severe side effects of chemotherapies, including Alpelisib. Successful recognition of precipitating factors for DKA allows for early intervention and in this setting, early coordination with the primary oncology team can be crucial. REFERENCE #1: Kitabchi, Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care., 32(7), 1335–1343. https://doi.org/10.2337/dc09-9032 REFERENCE #2: André F, Ciruelos E, Rubovszky G, et al; SOLAR-1 Study Group. Alpelisib for PIK3CA-mutated, hormone receptor-positive advanced breast cancer. N Engl J Med. 2019;380(20):1929-1940. [PubMed 31091374] REFERENCE #3: PIQRAY® (Alpelisib) Tablets HR+/HER2- Advanced Breast Cancer Treatment. PIQRAY® (Alpelisib) Tablets HR+/HER2- Advanced Breast Cancer Treatment, https://www.hcp.novartis.com/products/piqray/metastatic-breast-cancer/. DISCLOSURES: No relevant relationships by Natalie Berger No relevant relationships by Bridget Dolan No relevant relationships by Maninderjit Ghotra No relevant relationships by Shasawat Kumar No relevant relationships by Steven Lim No relevant relationships by Kian Parsa No disclosure on file for Frederick Rapoport" @default.
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• W4387245859 date "2023-10-01" @default.
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• W4387245859 title "(NOT SO) DIABETIC KETOACIDOSIS" @default.
• W4387245859 doi "https://doi.org/10.1016/j.chest.2023.07.1899" @default.
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