Objectives Hyperglycemia is a known side effect of anticancer chemotherapeutic drugs. This entity known as drug-induced diabetes mellitus usually does not present with the development of diabetic ketoacidosis (DKA). We hereby report a case of drug induced diabetes mellitus in a child with acute leukemia presenting with DKA. Case presentation We report a case of a teenage boy diagnosed with B cell acute lymphoblastic leukemia and was started on induction phase chemotherapy as per the Indian Collaborative Childhood Leukemia group (ICICLe) acute lymphoblastic leukemia-14 protocol. On day 12 of the induction phase, he developed hyperglycemia and presented to us with severe diabetic ketoacidosis (DKA). Serum anti glutamic acid decarboxylase 65 antibody levels were negative with low serum C peptide levels. Initially, the possibility of drug-induced acute pancreatitis was kept which was ruled out. Keeping the possibility of drug-induced hyperglycemia, the child was started on subcutaneous regular insulin which was titrated as per sugar records. Continuation of remaining chemotherapy was done by PEGylated l-asparaginase with titration of insulin as per home-based sugar records. Insulin requirement increased from 0.3 unit/kg/day to a maximum of 1 unit/kg/day during consolidation phase 1 with PEGylated l-asparaginase suggesting drug-induced hyperglycemia but subsequently insulin requirement decreased and insulin was stopped. Conclusion Drug induced diabetes mellitus can present as DKA during induction phase of ALL chemotherapy. A high index of suspicion and close monitoring are required. The insulin requirements in these patients can be very fluctuant and may become nil during the course of treatment.

中文翻译：

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一名正在接受 B 细胞急性淋巴细胞白血病治疗的儿童因一种新药引起的糖尿病而出现糖尿病酮症酸中毒。病例报告及文献综述

目的 高血糖是抗癌化疗药物的已知副作用。这种被称为药物诱发的糖尿病的实体通常不会随着糖尿病酮症酸中毒 (DKA) 的发展而出现。我们在此报告一例患有急性白血病并伴有 DKA 的儿童药物诱发糖尿病的病例。病例介绍 我们报告一例被诊断患有 B 细胞急性淋巴细胞白血病的十几岁男孩，并根据印度儿童协作白血病组 (ICICLe) 急性淋巴细胞白血病-14 方案开始诱导期化疗。在诱导期第 12 天，他出现高血糖，并出现严重的糖尿病酮症酸中毒 (DKA)。血清抗谷氨酸脱羧酶65抗体水平呈阴性，血清C肽水平较低。最初保留药物性急性胰腺炎的可能性，并予以排除。为了保留药物引起高血糖的可能性，孩子开始皮下注射常规胰岛素，并根据血糖记录进行滴定。剩余化疗的继续通过聚乙二醇化完成我-根据家庭血糖记录滴定胰岛素的天冬酰胺酶。在使用聚乙二醇化的巩固阶段 1 期间，胰岛素需求量从 0.3 单位/公斤/天增加到最多 1 单位/公斤/天我-天冬酰胺酶表明药物引起的高血糖，但随后胰岛素需求减少并停止胰岛素。结论 药物性糖尿病在ALL化疗诱导期可表现为DKA。需要高度怀疑和密切监视。这些患者的胰岛素需求可能非常波动，并且在治疗过程中可能为零。