Euglycemic Ketoacidosis in a Non-diabetic Patient After Tirzepatide Use: A Cautionary Tale

Tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, has emerged as a promising pharmacological agent for weight loss in both diabetic and non-diabetic individuals. However, its widespread use, particularly without close medical supervision, raises concerns about rare but serious adverse effects. We describe a case of a 48-year-old woman with a BMI of 30.4 kg/m² who initiated tirzepatide therapy via an online prescription. She self-titrated to a weekly dose of 5 mg over six weeks, achieving a 16-pound weight loss. One week prior to admission, she developed persistent diarrhea, appetite loss, nausea, and abdominal pain. On presentation, she was clinically dehydrated, with laboratory findings revealing a pH of 7.2, bicarbonate level of 17 mmol/L, and elevated ketones, while serum glucose remained normal. A diagnosis of tirzepatide-induced euglycemic ketoacidosis (EKA) was made. She was managed conservatively with fluid resuscitation and recovered without complications. This case highlights EKA as a rare but potentially serious adverse effect of tirzepatide, particularly in the context of appetite suppression and caloric restriction. It emphasizes the need for medical supervision and patient education when prescribing novel weight-loss agents.