Tirzepatide-induced ketoacidosis with hyperglycemia in a patient without diabetes

Abstract Tirzepatide,a dual GLP-1 and GIP receptor agonist, is increasingly used for weight management in both patients with diabetes and patients without diabetes. While gastrointestinal side effects such as nausea are common, severe metabolic complications like ketoacidosis are rare and often overlooked. We report the case of a 38-year-old woman with congenital heart disease who developed acute ketoacidosis with hyperglycemia following five months of tirzepatide therapy. Laboratory findings confirmed high anion gap metabolic acidosis, elevated ketones, and significant hyperglycemia. With supportive care, including intravenous fluids, insulin infusion, and electrolyte replacement, she recovered fully. This represents a rare case of tirzepatide-induced hyperglycemic ketoacidosis in a patient without diabetes. In contrast, the two previously reported cases by Singh and cols. and Iqbal and cols. involved patients without diabetes who developed euglycemic ketoacidosis with normal glucose levels while on tirzepatide. This case underscores the importance of vigilant monitoring for metabolic complications, including hyperglycemia and ketoacidosis, in patients without diabetes, particularly those with comorbidities.