Clinical Case Report on Tirzepatide
A woman in her thirties experienced a life-threatening medical emergency following her first dose of tirzepatide for weight loss. She presented to a hospital in Al Ain with persistent vomiting that had lasted for six days. The patient had no prior history of diabetes. Her symptoms included burning epigastric pain, significant fatigue, and a total inability to tolerate solid foods. Doctors documented her clinical experience in a recent case report published by Humaid Sadiq and his team at Tawam Hospital.
The patient was unable to consume more than small amounts of liquid, which compounded her physical distress. She denied any use of SGLT2 inhibitors or corticosteroids, and she did not report alcohol consumption. Her medical history was otherwise unremarkable, and she was not taking other medications known to trigger ketoacidosis. This specific presentation highlights a rare but severe risk profile for patients using dual incretin receptor agonists like tirzepatide.
Diagnostic Findings and Emergency Response
Initial physical examination revealed the patient was alert but suffering from discomfort. Her blood pressure was 116/77 mm Hg, with a heart rate of 98 beats per minute. A venous blood gas analysis provided the core evidence of her condition. The results showed a pH of 7.16, a bicarbonate level of 11 mmol/L, and an anion gap of 19. Her glucose levels were notably low at 2.5 mmol/L, while her beta-hydroxybutyrate levels reached 6.4 mmol/L.
Physicians diagnosed her with euglycemic ketoacidosis. Imaging studies, including a chest x-ray and an abdominal ultrasound, ruled out acute intra-abdominal pathology. The medical team initially treated her with intravenous normal saline, acetaminophen, metoclopramide, and pantoprazole. When these interventions failed to resolve the metabolic acidosis, the clinical team transferred her to the intensive care unit for specialized monitoring.
Recovery and Broader Medical Implications
Treatment in the ICU consisted of intravenous fluids, insulin, potassium, and dextrose. This intervention corrected her metabolic state over three days. She was discharged in stable condition, and a follow-up appointment showed no recurring symptoms. The case serves as a warning for providers to monitor patients closely when initiating weight-loss therapies, especially when gastrointestinal side effects emerge.
The medical authors noted that while tirzepatide remains effective for weight management, practitioners should remain alert for ketoacidosis in nondiabetic patients. Reduced oral intake caused by common side effects such as vomiting can trigger a starvation physiology. This leads to depleted glycogen stores and increased ketone production. Future clinical guidelines may need to address specific protocols for identifying these risks before they escalate into acute metabolic emergencies.