Table 1. Case analysis of literature on diabetic ketoacidosis caused by nivolumab.
| Number (Ref.) | Sex | Age (years) | Cancer | Dose | Occurrence time | Initial symptoms | Treatment | Stop/go on nivolumab | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| No. 1 (12) | Female | 54 | Melanoma | 2 mg/kg, q3w | After 16 cycles | Excessive drinking and urination, severe fatigue, delirium, fever, cold | Insulin therapy (route of administration unknown) | Go on | Continue insulin therapy |
| No. 2 (13) | Female | 68 | Melanoma | 3 mg/kg, q3w | Seven days after the 28th cycle | Abdominal pain, nausea, vomiting, severe fatigue, excessive drinking, and urination | Intravenous insulin and fluid replacement therapy | Stop | Continue insulin therapy |
| No. 3 (14) | Male | 77 | Renal cell carcinoma | 3 mg/kg, q2w | Fifteen days after the 6th cycle | Fatigue, nausea, vomiting | Insulin therapy (route of administration unknown) | Go on | Continue insulin therapy |
| No. 4 (15) | Male | 73 | Lung cancer | 3 mg/kg, q2w | Twenty-one days after the 11th cycle | Excessive drinking and urination, nausea, and vomiting | Insulin therapy (route of administration unknown) | Stop (aggravation of pneumonia) | Not described |
| No. 5 (16) | Male | 31 | NSCLC | Unknown | Thirteen days after the first cycle | Fatigue, excessive urination, excessive drinking | Intravenous insulin therapy | Go on | Continue insulin therapy |
| No. 6 (17) | Male | 73 | Melanoma | 3 mg/kg, q2w | Before the 4th cycle | Palpitations, fatigue | Intravenous insulin and fluid replacement therapy | Go on | Continue insulin therapy |
| No. 7 (18) | Male | 52 | Melanoma | Ipi 3 mg/kg + nivo 3 mg/kg, q3w | Eighteen days after the 3rd cycle | Polyuria, polydipsia, nausea, vomiting, weight loss | Insulin subcutaneous therapy | Stop | Continue insulin therapy |
| No. 8 (19) | Female | 74 | Melanoma | 2 mg/kg, q3w | Thirteen days after the 6th cycle | Nausea, vomiting, polyuria, dizziness | Intravenous insulin and fluid replacement therapy | Stop | Continue insulin therapy |
| No. 9 (20) | Male | 51 | Renal cell carcinoma | Unknown | The 45th day | Nausea, fatigue | Control blood glucose, the specific treatment plan is unknown | Stop | Continue insulin therapy |
| No. 10 (21) | Female | 55 | Melanoma | 2 mg/kg, q3w | The 12th month | Vomiting, delirium, excessive drinking and urination | Insulin subcutaneous therapy | Go on | Continue insulin therapy |
| No. 11 (22) | Male | 54 | Melanoma | Ipi 3 mg/kg + nivo 3 mg/kg, q3w | After the 6th cycle | Fatigue, myalgia, nausea, vomiting | Insulin was administered intravenously and fluid rehydration was followed by subcutaneous insulin injection | Stop | Continue insulin therapy |
| No. 12 (23) | Male | 83 | Maxillary sinus squamous cell carcinoma | 240 mg/kg, q2w | The 3rd month | No subjective symptoms | Insulin therapy (route of administration unknown) | Stop (because of colitis) | Continue insulin therapy |
| No. 13 (24) | Female | 47 | Lung cancer | 3 mg/kg, q2w | Ten days after the 2nd cycle (24 days) | Excessive drinking and urination, weight loss, vomiting, confusion, fatigue, dehydration, low blood pressure | Insulin was administered intravenously and fluid rehydration was followed by subcutaneous insulin injection | Go on | Continue insulin therapy |
| No. 14 (25) | Male | 66 | Melanoma | 2 mg/kg, q3w | Ten days after the 6th cycle | Nausea, vomiting, anorexia | Insulin was administered intravenously and fluid rehydration was followed by subcutaneous insulin injection | Go on | Continue insulin therapy |
| No. 15 (26) | Female | 34 | Lung cancer | 3 mg/kg, q2w | Ten days after the 2nd cycle (28 days) | Abdominal pain, nausea, fatigue | Intravenous insulin and fluid replacement therapy | Go on | Continue insulin therapy |
| No. 16 (9) | Female | 56 | Lung cancer | Dose unknown, q2w | Five days after the 3rd cycle (33 days) | Excessive drinking and urination, coma, agitation, | Insulin was administered intravenously and fluid rehydration was followed by subcutaneous insulin injection | Go on | Continue insulin therapy |
| No. 17 (27) | Male | 42 | Lung cancer | 3 mg/kg, q2w | Eighteen days after the 4th cycle | No subjective symptoms | Insulin was administered intravenously and fluid rehydration was followed by subcutaneous insulin injection | Stop (poor blood sugar control) | Continue insulin therapy |
| No. 18 (28) | Male | 49 | Renal cell carcinoma | 3 mg/kg, q2w | After the 21st cycle | Fatigue, drowsiness, weight loss, and excessive drinking and urination | Insulin was administered intravenously and fluid rehydration was followed by subcutaneous insulin injection | Go on | Continue insulin therapy |
| No. 19 (29) | Female | 59 | Metastatic mucosal melanoma | Dose unknown, ipilimumab/nivolumab | Three days after receiving the 3rd cycle | Nausea, vomiting and generalized weakness | Insulin | Do not mention it | Do not mention it |
| No. 20 (30) | Female | 60 | Advanced renal cell carcinoma | Nivolumab (3 mg/kg) and ipilimumab (1 mg/kg), q3w | Seven months (216 days) after the first administration and about half a year (174 days) after the last administration | General malaise, hyperglycemia, metabolic acidosis, and presence of ketone bodies in urine | Injections of insulin | Stop | Continue insulin therapy |
| No. 21 (31) | Male | 77 | Metastatic high-grade neuroendocrine tumor | 200 mg, q2w | After 15 cycles | Worsening fatigue, polyuria, and polydipsia of 1 week’s duration |
Intravenous insulin | Stop | Continue insulin therapy |
Ipi, ipilimumab; nivo, nivolumab; NSCLC, non-small cell lung cancer.