CureusMay 30, 2025

Danger of Ketoacidosis with Normal Blood Sugar in a Non-Diabetic Patient After Taking Tirzepatide

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jan 20, 2026

Abstract

A 48-year-old woman lost 16 pounds after self-titrating tirzepatide to 5 mg weekly over six weeks.

The patient experienced persistent diarrhea, appetite loss, nausea, and abdominal pain prior to hospital admission.
Laboratory findings included a pH of 7.2, bicarbonate level of 17 mmol/L, and elevated ketones, with normal serum glucose.
A diagnosis of tirzepatide-induced euglycemic ketoacidosis (EKA) was made.
The patient was managed with fluid resuscitation and recovered without complications.
EKA may be a rare but serious adverse effect associated with tirzepatide, especially during appetite suppression and caloric restriction.

Simplified

Tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, has emerged as a promising pharmacological agent for weight loss in both diabetic and non-diabetic individuals. However, its widespread use, particularly without close medical supervision, raises concerns about rare but serious adverse effects. We describe a case of a 48-year-old woman with a BMI of 30.4 kg/m² who initiated tirzepatide therapy via an online prescription. She self-titrated to a weekly dose of 5 mg over six weeks, achieving a 16-pound weight loss. One week prior to admission, she developed persistent diarrhea, appetite loss, nausea, and abdominal pain. On presentation, she was clinically dehydrated, with laboratory findings revealing a pH of 7.2, bicarbonate level of 17 mmol/L, and elevated ketones, while serum glucose remained normal. A diagnosis of tirzepatide-induced euglycemic ketoacidosis (EKA) was made. She was managed conservatively with fluid resuscitation and recovered without complications. This case highlights EKA as a rare but potentially serious adverse effect of tirzepatide, particularly in the context of appetite suppression and caloric restriction. It emphasizes the need for medical supervision and patient education when prescribing novel weight-loss agents.

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Human subjects: 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.

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Danger of Ketoacidosis with Normal Blood Sugar in a Non-Diabetic Patient After Taking Tirzepatide

Abstract

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