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Document Type

Conference Proceedings

Abstract

Objective: Tirzepatide, a dual GLP-1/GIP receptor agonist, is increasingly prescribed for weight management in diabetic and non-diabetic patients. Although gastrointestinal side effects are common, metabolic complications like ketoacidosis are rarely reported. This case highlights an unusual presentation of tirzepatide-induced hyperglycemic ketoacidosis in a non-diabetic patient with congenital heart disease. Case Report: A 38-year-old non-diabetic woman with a history of bicuspid aortic valve and repaired aortic coarctation presented with two days of nausea, vomiting, abdominal pain and poor oral intake after five months of tirzepatide therapy for weight loss. She denies diarrhea or alcohol use. Physical exam reveals moderate left lower quadrant tenderness. Laboratory evaluation reveals high anion gap metabolic acidosis, marked ketonemia, and elevated glucose of 285 mg/dL, consistent with hyperglycemic ketoacidosis, despite having an HbA1c of 5.1%. Toxic and infections causes were excluded. Following treatment with the standard diabetic ketoacidosis protocol and discontinuing tirzepatide, the patient’s anion gap normalized, ketones cleared, and she made a full recovery. Conclusion: This case represents the first documented instance of tirzepatide-associated hyperglycemic ketoacidosis in a non-diabetic patient. Two previously reported cases involved euglycemic presentations. The mechanism may involve ketogenesis driven by reduced oral intake due to tirzepatide induced appetite suppression, combined with transient hyperglycemia due to stress-induced hormonal effects. Clinicians should be aware that hyperglycemic or euglycemic ketoacidosis may occur at any stage of treatment with dual GLP-1/GIP agonists. This understanding allows for prevention of severe metabolic derangements via consistent monitoring and emphasizes the need to develop updated dual GLP-1/GIP agonist-associated ketoacidosis protocols.

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