Intractable Vomiting in the Setting of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist and Cannabis Usage

The prevalence of type 2 diabetes mellitus has increased drastically over the past century. In the past few years, Glucagon-Like Peptide-1 (GLP-1) receptor agonists have gained significant popularity for medical management of type 2 diabetes mellitus, especially in patients with comorbid conditions. In this report, we describe the case of a 55‑year‑old woman with a history of chronic kidney disease, diabetes mellitus type 2 with neuropathy, peripheral vascular disease, and prior pancreatitis, who presented with severe gastrointestinal symptoms, sepsis physiology, and evidence of metabolic derangement shortly after up‑titration of tirzepatide therapy, consistent with the established temporal relationship of GLP-1 dose titration and gastrointestinal side effects. Her course was further complicated by gastrointestinal bleeding, hemodynamic instability, and the need for multidisciplinary management. This case highlights important diagnostic considerations related to the gastrointestinal adverse effects of incretin-based therapies and underlines the challenges of managing complex, multimorbid patients with overlapping clinical syndromes. This case outlines the importance of a multidisciplinary approach, including endocrinology, gastroenterology, and cardiology, in order to manage complex adverse drug reactions.