01 July 2026
: Case report 
Starvation-Type Euglycemic Ketoacidosis After Unsupervised Tirzepatide Use in a Non-Obese, Non-Diabetic Woman
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Eslam Elsayed Abdelshafey
ABCDEF 1, Khaled Sewify ABCDEF 1*, Atheer Almutairi ABC 1, Ragheb Elmessery ABCDEF 1, Sara Alotaishan DEF 2, Yasmin Youssuf Al-Gindan EF 2, Manal Ali Ahmad EF 3, Wael Gomaa ABCDEF 1
DOI: 10.12659/AJCR.952750
Am J Case Rep 2026; 27:e952750
Figure 1 Clinical course of tirzepatide-associated euglycemic ketoacidosisOriginal schematic created from the clinical timeline and laboratory values in this case report. The figure summarizes tirzepatide dose escalation from 2.5 mg to 5 mg weekly, 4 days of vomiting and poor oral intake, emergency department findings of high anion gap metabolic acidosis with ketonemia and normal lactate levels, initial crystalloid resuscitation with persistent acidosis, intensive care unit management with 10% dextrose, lactated Ringer’s solution, thiamine, electrolyte monitoring, ondansetron, discontinuation of tirzepatide, and recovery by 36 hours with closure of the anion gap without bicarbonate therapy. Abbreviations: D10, 10% dextrose; ED, emergency department; HCO3−, bicarbonate; ICU, intensive care unit; q6h, every 6 hours.