MON-637 A Case of Euglycemic Ketoacidosis Following Treatment With an SGLT2 Inhibitor and Tirzepatide

Abstract Disclosure: E.J. Louwagie: None. J.N. Diego: None. C.S. Farooqi: None. M.M. Kamal: None. As prescriptions for sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and the novel agent tirzepatide continue to increase, a rare yet serious condition has emerged: euglycemic ketoacidosis (EKA). EKA is a life-threatening condition similar to diabetic ketoacidosis, except diagnosis is more challenging because patients present with normal to slightly elevated blood glucose levels. Tirzepatide is a novel dual agonist at GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors and is approved for treatment of diabetes and weight loss. Here, we describe a unique case in which a young male patient placed on both an SGLT2 inhibitor and tirzepatide developed EKA. The patient’s diagnosis was delayed, and he required treatment and monitoring in an intensive care unit. Clinicians should be aware of this rare yet potentially fatal complication as well as potential risk factors. Presentation: Monday, July 14, 2025