SHM Converge Scientific Abstract ePoster Gallery-Unmasking Euglycemic Dka in Tirzepatide Therapy: A Case Report

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This case report describes a 60-year-old woman with type 2 diabetes who developed euglycemic diabetic ketoacidosis (euDKA) shortly after starting tirzepatide 7.5 mg weekly. She presented after one week of nausea, vomiting, abdominal discomfort, fatigue, reduced oral intake, and unintentional weight loss. She denied infection, alcohol use, chest pain, dyspnea, and diarrhea. On exam, she was tachycardic and mildly dehydrated with generalized lower abdominal tenderness.<br /><br />Although her blood glucose was only 139 mg/dL, laboratory findings showed high anion gap metabolic acidosis and ketosis: bicarbonate 17 mmol/L, anion gap 25, beta-hydroxybutyrate 5.3 mmol/L, and arterial pH 7.29. These findings were consistent with euDKA, a rare and easily missed form of DKA that can occur without marked hyperglycemia.<br /><br />The report highlights that euDKA is traditionally linked to SGLT2 inhibitors, but GLP-1–based therapies, including tirzepatide, may also contribute. Proposed mechanisms include appetite suppression, gastrointestinal side effects causing reduced caloric intake, delayed gastric emptying, and altered insulin-glucagon balance, leading to relative insulin deficiency and increased ketone production.<br /><br />She was treated with IV fluids containing dextrose and potassium, insulin infusion, close glucose and electrolyte monitoring, and later transitioned to subcutaneous insulin. Her metabolic abnormalities resolved within 48 hours, and her anion gap closed twice. She was discharged in stable condition with advice to avoid GLP-1/GIP agonists and follow up with endocrinology.<br /><br />The authors emphasize that clinicians should consider euDKA in patients taking tirzepatide or similar agents who present with nausea, vomiting, abdominal pain, or malaise, even when glucose is not significantly elevated.

Asset Subtitle

Deniece Meñez

Meta Tag

Author List Deniece Meñez, Mimita Rahman, Neil Gambhir, Rebecca Zeidman, Rujuta Patel, Tina J. Kana, Umair Abbas

Category Clinical Vignettes

Concept Euglycemic Diabetic Ketoacidosis

Concept Diabetic Ketoacidosis

Concept Ketosis

Concept Anion Gap Metabolic Acidosis

Concept Blood Glucose

Distinguished Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Deniece Meñez

Track Adult

Keywords

euglycemic diabetic ketoacidosis

tirzepatide

type 2 diabetes

GLP-1/GIP agonist

high anion gap metabolic acidosis

ketosis

nausea and vomiting

beta-hydroxybutyrate

insulin infusion

delayed gastric emptying

Euglycemic Diabetic Ketoacidosis

Diabetic Ketoacidosis

Ketosis

Anion Gap Metabolic Acidosis

Blood Glucose