Study wrapper · #431
Starvation-Type Euglycemic Ketoacidosis After Unsupervised Tirzepatide Use in a Non-Obese, Non-Diabetic Woman.
Editor's note
A single case report describing a 30-year-old woman without diabetes or obesity (BMI 24.8) who developed euglycemic ketoacidosis after self-administering tirzepatide obtained without a prescription for weight loss, then raising her own dose. She presented with days of severe vomiting and poor intake; labs showed high-anion-gap metabolic acidosis with near-normal glucose and elevated ketones. Symptoms resolved within 36 hours after stopping the drug and receiving dextrose, fluids and supportive care. As a case report this is the weakest tier of evidence and cannot establish how often this happens. Its editorial value is the context: this is a documented harm tied to unsupervised, non-prescribed use outside the drug's approved population. The authors describe the mechanism as starvation ketosis driven by appetite suppression and vomiting, not diabetic ketoacidosis. A useful cautionary data point about self-sourced use.
Plain-language abstract
Doctors describe one patient: a 30-year-old woman who was not overweight and did not have diabetes. She bought tirzepatide without a prescription to lose weight, injected it weekly, and increased her own dose after a week. She then developed four days of severe nausea, roughly ten episodes of vomiting a day, poor food intake and abdominal pain. Blood tests showed her blood had become dangerously acidic, with high ketone levels but normal blood sugar, a pattern sometimes linked to prolonged low food intake. She was admitted to intensive care, the drug was stopped, and she was given sugar solution, fluids, vitamins and anti-nausea medicine. She recovered within about a day and a half without needing insulin. The authors warn that severe nausea and reduced eating on tirzepatide can, in rare cases, lead to this acid buildup even in people without diabetes. This is a single report, so it shows what can happen but not how common it is.