Humaid Sadiq, Zahra Amini, Mansoor M Husain, David O Alao, Thiagarajan Jaiganesh
Tirzepatide has emerged as an effective therapeutic option for the management of obesity and type 2 diabetes mellitus because of its substantial benefits in weight reduction and glycemic control. Gastrointestinal adverse effects are common, whereas serious metabolic complications such as ketoacidosis remain rare. We describe the case of a woman in her early 30s with class II obesity who developed persistent vomiting, epigastric pain, and fatigue six days after her first tirzepatide injection. Laboratory investigations revealed mild hypoglycemia and high-anion-gap metabolic acidosis with markedly elevated ketone levels. Following an initial treatment in the emergency department (ED), she was admitted to the intensive care unit (ICU). She was managed with intravenous fluids, electrolytes, dextrose, and insulin, and she made a good recovery within 48 hours. The case highlights the potential life-threatening complications of dual incretin receptor agonists and the need to increase clinician awareness.