An Online Prescription for Hospitalisation: Euglycaemic Ketoacidosis Caused by an Online Tirzepatide Prescription

Obesity affects a significant proportion of the UK population, and tirzepatide, a dual glucagon-like peptide (GLP-1) and gastric inhibitory polypeptide (GIP) receptor agonist, is increasingly being prescribed by online services as well as primary care for weight loss in both diabetic and non-diabetic patients. We present the case of a 61-year-old woman with no past medical history, who developed euglycaemic ketoacidosis following six weeks of tirzepatide (Mounjaro®) therapy, which was initiated via an online consultation for weight loss. Despite normal blood glucose levels, she exhibited significant ketonaemia and metabolic acidosis, which resolved with intravenous fluid resuscitation and replacement. This case brings to light the importance of treating clinicians being aware of the potential adverse side effects of euglycaemic ketoacidosis in patients using tirzepatide, and highlights the risk when these medications are prescribed via novel care pathways, which have less rigid monitoring paradigms than traditional prescribing models. Early recognition of, and prompt management, are important to ensure the mitigation of morbidity associated with this under-recognised adverse effect.