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
Table 2 Serial acid-base, ketone, lactate, and electrolyte trend during the first 36 hours.
| Variable | 0 h | 6 h | 12 h | 18 h | 24 h | 30 h | 36 h |
|---|---|---|---|---|---|---|---|
| pH | 7.15 | 7.11 | 7.23 | 7.28 | 7.33 | 7.40 | 7.41 |
| PCO (mmHg) | 30 | 31 | 25 | 33 | 34 | 31 | 35 |
| Sodium (mEq/L) | 134 | 139 | 137 | 135 | 133 | 134 | 133 |
| Potassium (mEq/L) | 4.6 | 4.2 | 3.5 | 3.3 | 3.5 | 3.2 | 4.0 |
| Lactate (mmol/L) | 1.5 | 1.0 | 1.1 | 1.0 | 0.7 | 0.6 | 1.1 |
| BE (mEq/L) | −17 | −18.8 | −4.2 | −10 | −7.2 | −4.7 | −1.1 |
| Bicarbonate (mEq/L) | 10.5 | 9.8 | 10.5 | 15.5 | 17.9 | 19.2 | 22.2 |
| Anion gap (mEq/L) | 24 | 20 | 14 | 13 | 9 | 10 | 9 |
| Ketones (mmol/L) | 4.5 | 3.2 | 2.3 | 1.1 | 0.2 | 0.1 | 0.1 |
| Abbreviations: BE, base excess; PCO, partial pressure of carbon dioxide. | |||||||