DOI: 10.12890/2024_004357

Tirzepatide-induced ketoacidosis in non-diabetic patients

Authors

  • Pathan Mohamad Rafe Iqbal Internal Medicine Department, New Ahamdi Hospital, Kuwait Oil Company, Fahahil, Kuwait
  • Ossama Sajeh Maadarani Internal Medicine Department, Ahmadi Hospital, Kuwait Oil Company, Fahahil, Kuwait 0000-0003-3658-4709
  • Zouheir Ibrahim Bitar Internal Medicine Department, Ahmadi Hospital, Kuwait Oil Company, Fahahil, Kuwait

zbitar2@hotmail.com

Keywords

Ketoacidosis, tirzepatide, obesity

Abstract

Background: Tirzepatide is a novel glucagon-like peptide 1/glucose-dependent insulinotropic peptide (GLP-1/GIP) receptor agonist. It was recently approved for diabetes control and weight reduction in non-diabetic patients.
Case description: We report the first case of ketoacidosis after the use of tirzepatide in an obese non-diabetic patient, secondary to the possibility of starvation ketoacidosis and insulin resistance.
Conclusion: The dual-acting GLP-1 and GIP receptor agonists, tirzepatide, can induce ketoacidosis in obese non-diabetic patients.

View the entire article

Downloads

References

  1. Halperin ML, Hammeke M, Josse RG, Jungas RL. Metabolic acidosis in the alcoholic: a pathophysiologic approach. Metabolism 1983;32:308–305.
  2. Willard FS, Douros JD, Gabe MB, Showalter AD, Wainscott DB, Suter TM, et al. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight 2020;5:e140532.
  3. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al. SURMOUNT-1 Investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med 2022;387:205–216.
  4. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239–245
  5. Davids MR, Segal AS, Brunengraber H, Halperin ML. An unusual cause for ketoacidosis. QJM 2004;97:365–376.
  6. Nauck MA, Quast DR, Wefers J, Pfeiffer AFH. The evolving story of incretins (GIP and GLP-1) in metabolic and cardiovascular disease: a pathophysiological update. Diabetes Obes Metab 2021;23:5–29.
  7. Frías JP. Tirzepatide: a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) dual agonist in development for the treatment of type 2 diabetes. Expert Rev Endocrinol Metab 2020;15:379–394.
  8. Del Prato S, Kahn SE, Pavo I, Weerakkody GJ, Yang Z, Doupis J, et al. SURPASS-4 Investigators. Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial. Lancet 2021;398:1811–1824.
  9. Trujillo J. Safety and tolerability of once-weekly GLP-1 receptor agonists in type 2 diabetes. J Clin Pharm Ther 2020;45:43–60.
  10. Shyangdan DS, Royle P, Clar C, Sharma P, Waugh N, Snaith A. Glucagon-like peptide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev 2011;2011:CD006423
  11. Frías JP, Davies MJ, Rosenstock J, Pérez Manghi FC, Fernández Landó L, Bergman BK, et al. SURPASS-2 Investigators. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med 2021;385:503–515.
  12. Yang Z, Yu M, Mei M, Chen C, Lv Y, Xiang L, et al. The association between GLP-1 receptor agonist and diabetic ketoacidosis in the FDA adverse event reporting system. Nutr Metab Cardiovasc Dis 2022;32:504–510.
  13. Cahill GF Jr. Fuel metabolism in starvation. Annu Rev Nutr 2006; 26:1–22.
  14. Samocha-Bonet D, Dixit VD, Kahn CR, Leibel RL, Lin X, Nieuwdorp M, et al. Metabolically healthy and unhealthy obese – the 2013 Stock Conference report. Obes Rev 2014;15: 697–708.
  15. Tong Y, Xu S, Huang L, Chen C. Obesity and insulin resistance: pathophysiology and treatment. Drug Discov Today 2022;27:822–830.

Published

2024-03-11

Issue

Vol. 11 No. 4 (2024)

Categories

How to Cite

1.
Iqbal PMR, Maadarani OS, Bitar ZI. Tirzepatide-induced ketoacidosis in non-diabetic patients. EJCRIM [Internet]. 2024 Mar. 11 [cited 2026 Nov. 3];11(4). Available from: https://ejcrim.com/index.php/ejcrim/article/view/4357

Most read articles by the same author(s)