CureusMar 3, 2026

Normal-Blood-Sugar Ketoacidosis After Using Fake Semaglutide for Weight Loss

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 4, 2026

Abstract

An 18-year-old woman developed euglycemic ketoacidosis after self-administering semaglutide purchased online.

Euglycemic ketoacidosis is a rare but recognized complication associated with glucagon-like peptide-1 (GLP-1) receptor agonists.
Reduced oral intake and gastrointestinal side effects can lead to ketone body formation during starvation states.
The off-label use of GLP-1 agents for weight loss without medical supervision may increase the risk of this condition.
Laboratory findings included high-anion gap metabolic acidosis, elevated β-hydroxybutyrate levels, and normal blood sugar.
Rapid improvement was noted with intravenous fluids, dextrose infusion, and supportive therapy.
There are concerns regarding the safety and dosing of GLP-1 products obtained from unregulated online sources.

Simplified

Euglycemic ketoacidosis is a rare but increasingly recognized adverse effect related to the use of glucagon-like peptide-1 (GLP-1) receptor agonists. Reduced oral intake in combination with gastrointestinal side effects can trigger a starvation state and ketone body formation. The growing off-label use of glucagon-like peptide-1 (GLP-1) agents for weight loss, particularly without medical supervision, may further increase the risk of this serious complication. An 18-year-old woman with no medical history presented with persistent nausea, intractable vomiting, and reduced oral intake for three days. Ten days earlier, she had initiated semaglutide purchased online and self-administered escalating doses without supervision. Laboratory evaluation revealed high-anion gap metabolic acidosis (pH 7.24, bicarbonate 14 mmol/L, anion gap 24 mEq/L), markedly elevated β-hydroxybutyrate (5.9 mmol/L), and normoglycemia (60 mg/dL), consistent with euglycemic ketoacidosis. She improved rapidly with intravenous fluids, dextrose infusion, and supportive therapy and was discharged in stable condition after 36 hours. This case highlights an uncommon but serious adverse condition observed in association with semaglutide use in a non-diabetic patient. Contributing factors include possible inappropriate high-dose initiation and uncertainties in dosing and purity related to unregulated online products. Clinicians should be aware of euglycemic ketoacidosis as a potential complication of GLP-1 receptor agonists, particularly when obtained through unsafe sources and used without proper medical monitoring.

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Competing interests

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

PubMed

Normal-Blood-Sugar Ketoacidosis After Using Fake Semaglutide for Weight Loss

Abstract

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