Unmasking Semaglutide-Induced Gastroparesis: The Dangers of Rapid Dose Escalation in a Diabetic Patient

Gastroparesis is a chronic disorder characterized by delayed gastric emptying without mechanical obstruction, causing symptoms such as nausea, vomiting, and abdominal discomfort. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist used for type 2 diabetes, can slow gastric motility and induce gastroparesis. We present a case of a 48-year-old woman with type 2 diabetes, who developed persistent nausea and vomiting after resuming semaglutide at 2 mg subcutaneously once weekly without following the recommended stepwise titration schedule (typically initiated at 0.25 mg weekly with gradual escalation). Shortly thereafter, she developed acute kidney injury secondary to dehydration. Imaging also demonstrated left-sided colitis, for which she received antibiotic therapy. Gastroparesis was suspected due to semaglutide use. Treatment with metoclopramide and cessation of semaglutide resulted in symptom resolution and recovery. Thus, semaglutide-induced gastroparesis should be considered in diabetic patients presenting with gastrointestinal symptoms, especially with rapid dose escalation. Early recognition and discontinuation of the drug can lead to swift symptom resolution and prevent complications.