17 December 2024
: Case report 
Exploring Hypoglycemic Ketoacidosis in Nondiabetic Patients on Tirzepatide: Is Starvation the Culprit?
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Adverse events of drug therapy, Clinical situation which can not be reproduced for ethical reasons, Rare coexistence of disease or pathology
Zouheir Bitar
ACDE 1,2*, Heba M. Abdelraouf BDF 2, Rania A. Maig ABDE 2, Ossama Maadarani EG 1, Zainab Zouheir Bitar BC 3, Hussien Dashti AD 2
DOI: 10.12659/AJCR.946133
Am J Case Rep 2024; 25:e946133
Table 1. Clinical characteristics.
| Item | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|
| Age/sex | 29/F | 34/F | 17/F | 26/F |
| BMI (kg/m) | 32 | 31.3 | 30.4 | 30.8 |
| Dehydration severity | Severe | Mild | Mild | Mild |
| Abdominal pain duration (duration in days) | 5 | 7 | 2 | 4 |
| Vomiting (frequency/day, duration in days) | 3, 5 | 4, 2 | 3, 2 | 3, 1 |
| Diarrhea (duration in days) | No | 3 | 3 | 3 |
| Duration of symptoms (days) | 5 | 2 | 2 | 4 |
| Dose of tirezaptide | 2.5 mg for 4 weeks, then 5 mg for 3 weeks | 2.5 mg for 4 weeks, then 5 mg for 2 weeks | 2.5 mg for 4 weeks, then 5 mg for 1 week | 2.5 mg for 4 weeks, then 5 mg for 2 weeks |
| Duration of tirzeptide until admission (weeks) | 7 | 6 | 5 | 6 |
| Weight loss (kg) | 5 | 7 | 8 | 7 |
| Calorie intake/day | 1400 | 1400 | 1500 | 1200 |
| Fluid resuscitation | Riger lactate | Dextrose 5%/saline infusion | Dextrose 10% for 1 h followed by dextrose 5% with saline | Dextrose 10% followed by ringer lactate |
| Ultrasound abdomen | Fatty liver grade 1 | Fatty liver grade 1 | Fatty liver grade 1 | Fatty liver grade 1 |
| Outcome | Admitted to ward | Ward admission | Ward admission | Ward admission |