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Tirzepatide-Associated Euglycemic Diabetic Ketoacidosis in the Absence of Sodium-Glucose Cotransporter-2 Inhibitor Use: A Case Report
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DOI：10.1016/j.jemermed.2026.01.002.png)
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Abstract
En 中文
Background: Euglycemic diabetic ketoacidosis (EDKA) is most commonly associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. However, emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists and dual incretin agents such as tirzepatide (Mounjaro) may also precipitate EDKA, though reports remain rare. Case Report: We report a case of EDKA in a patient on tirzepatide monotherapy, with no concurrent SGLT2 inhibitor use. The patient presented with nausea, vomiting, and abdominal pain. Laboratory evaluation revealed a severe anion gap metabolic acidosis (CO2 7 mmol/L, anion gap 28, pH 7.1) and ketonuria, with mild hyperglycemia (glucose 167 mg/dL). The patient was managed with intravenous fluids, dextrose, and insulin infusion per standard diabetic ketoacidosis protocol, resulting in resolution of the anion gap. Study Objective: This case highlights a potential association between tirzepatide and EDKA, possibly related to mechanisms involving starvation ketosis and reduced insulin availability. Why Should an Emergency Physician Be Aware of This?: Emergency physicians should consider EDKA in patients taking incretin-based therapies such as tirzepatide who present with metabolic acidosis and ketosis in the absence of significant hyperglycemia. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/)
Keywords:
Tirzepatide
Euglycemic diabetic ketoacidosis
GLP-1 receptor agonist
Emergency medicine
Case report
Ketosis
Mounjaro
Diabetes management
Starvation ketosis
Non-SGLT2 inhibitor DKA
Journal
J
IF:
1.3
Papers:
233
Citations:
0
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Cited Papers