Euglycemic Ketoacidosis From Semaglutide in a Patient Without Diabetes

Euglycemic ketoacidosis is a medical emergency characterized by euglycemia, metabolic acidosis, and ketonemia. It is a well-recognized adverse event in patients with diabetes taking sodium-glucose cotransporter-2 inhibitors. However, little has been reported about euglycemic ketoacidosis using glucagon-like peptide-1 (GLP-1) receptor agonists like semaglutide. We present a case of euglycemic ketoacidosis in a young female without diabetes who was taking semaglutide for weight loss for the last 7 months. She was treated with bicarbonate-containing dextrose infusion, which improved the ketoacidosis rapidly. The incidence of euglycemic ketoacidosis will likely increase with the increasing use of GLP-1 inhibitors, and recognizing the signs and symptoms of this life-threatening condition is essential to treat it effectively. Our literature search identified 1 reported case of euglycemic ketoacidosis in a patient without diabetes associated with tirzepatide but none with semaglutide.