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 2. Laboratory test results.
| Item (units) | Case 1 | Case 2 | Case 3 | Case 4 | Reference range |
|---|---|---|---|---|---|
| Glucose level on admission (mmol/L) | 3 | 2.8 | 2.9 | 3.1 | 4–6 |
| pH | 7.24 | 7.3 | 7.31 | 7.3 | 7.38–7.42 |
| HCO3 | 16 | 20 | 21.3 | 20.3 | 22–26 |
| Ketone level (mmol/L) | 4.5 | 5 | 1.2 | 3 | <0.2 |
| White blood count | 9.4 | 3.3 | 7.3 | 8.6 | 4–10×10/L |
| Hemoglobin (g/dL) | 14.8 | 13.0 | 12.5 | 16.5 | 12–15 |
| Platelet Count | 440×10/L | 140×10/L | 221×10/L | 322×10/L | 140–400 |
| Sodium (mmol/L) | 137 | 139 | 136 | 139 | 136–145 |
| Serum potassium (mmol/L) | 4.2 | 3.4 | 4 | 3.9 | 3.5–5.1 |
| Blood urea nitrogen, (mmol/L) | 2.6 | 1.8 | 3.5 | 2 | 2.14–7.14 |
| Corrected calcium (mmol/L) | 2.42 | 2.12 | 2.3 | 2.5 | 2.2–2.6 |
| Phosphorus (mmol/L) | 0.9 | 0.7 | 1.3 | 1.3 | 0.81–1.45 |
| Magnesium (mmol/L) | 0.7 | 0.85 | 1.2 | 0.8 | 0.66–1.07 |
| Total bilirubin (umol/L) | 10 | 12 | 30 | 21 | 2–17 |
| Gamma glutamyl transpeptidase (U/L) | 8 | 12 | 30 | 45 | 3–40 |
| Aspartate amino transf (AST/SGOT) (U/L) | 12 | 13 | 20 | 14 | 5–32 |
| Creatinine (umol/L) | 45 | 69 | 66 | 94 | 62–106 |
| HbA1c | 5 | 4.3 | 6.3 | 6.4 | <5.7 |
| Uric acid (umol/L) | 359 | 504 | 510 | 470 | 160–430 |
| Amylase (U/L) | 63 | 70 | 35 | 20 | 28–100 |
| Lipase (U/L) | 25 | 35 | 35 | (3–60) | |
| C-reactive protein (mg/L) | 7 | 3 | 9 | 23.7 | 0–5 |
| Lactate (mmol/L) | 1.0 | 0.9 | 1.5 | <1 | |
| Salicylates (mg/dL) | 3 | 1 | 0 | 0 | 50–300 |