Ketoacidosis with Normal Blood Sugar After Using Both an SGLT2 Inhibitor and Tirzepatide

A patient developed euglycemic ketoacidosis after starting tirzepatide and an SGLT2 inhibitor for type 2 diabetes.

• Euglycemic ketoacidosis is a serious condition that can lead to systemic acidosis and organ damage.
• Unlike diabetic ketoacidosis, patients with euglycemic ketoacidosis have normal to slightly elevated blood glucose levels.
• The condition has been increasingly associated with SGLT2 inhibitors and GLP-1 receptor agonists.
• This case is the first reported instance of euglycemic ketoacidosis occurring following the initiation of tirzepatide.
• The patient required intensive care for treatment and monitoring to achieve full recovery.
• Awareness of this rare but potentially fatal complication is important for clinicians prescribing tirzepatide.

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