Case presentation A 61-year-old man presented to the emergency department with nausea, malaise, polyuria, vomiting, dizziness, and decreased PO intake. He had a history of metastatic melanoma of the lung and chest wall. He had been on a therapy of ipilimumab and nivolumab and had also been on a combination immunotherapy of anti-PD-1 and anti-CTLA-4. He developed a maculopapular rash after three days of immunotherapy as a side effect.
He was put on a high dose of prednisone, following which the patient began complaining of worsening fatigue and nausea. He also appeared to be highly distressed. Physical investigations Heart rate - 126 beats per minute Respiratory rate - 24 breaths per minute Blood pressure - 90/50 mmHg Laboratory investigations Potassium - 9.5 mmol/L Bicarbonate - <10 mmol/L Sodium - 127 mmol/L Blood glucose - 1211 mg/dL Anion gap - >31 mmol Arterial blood pH - 7.14…
