Work

Euglycemic Ketoacidosis Following Coadministration of an SGLT2 Inhibitor and Tirzepatide

Year: 2025

Type: article

Abstract: Euglycemic ketoacidosis (EKA) is a life-threatening condition characterized by ketone production leading to systemic acidosis, dehydration, and end-organ damage. It presents similarly to diabetic ketoacidosis, except that patients have normal to slightly elevated blood glucose levels. EKA is an increasingly recognized complication of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. Recently the novel dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist tirzepatide was approved for treatment of diabetes and weight loss. Here, we describe a unique case in which a patient placed on both an SGLT2 inhibitor and tirzepatide to treat type 2 diabetes was admitted to the intensive care unit (ICU) for EKA. To our knowledge, this is the first case detailing a patient developing this serious condition after starting tirzepatide for diabetes. The patient required treatment and monitoring in an ICU to make a full recovery. As tirzepatide is a relatively new medication whose side effect profile has yet to be fully characterized, clinicians should be aware of this rare yet potentially fatal complication.

Source: JCEM Case Reports

DOI: 10.1210/jcemcr/luaf028

Authors: Eli J Louwagie, Jessica N Diego, Crystal S Farooqi, Madiha M Kamal

Institution: LewisGale Hospital Montgomery

Language: English

Topic: Diabetes Treatment and Management

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $930