Don't Play with Your Nodule: Case Report of Tachycardia and Other Adverse Reactions from Manipulation of an Exenatide Injection Site Nodule.

BACKGROUND: Type II diabetes mellitus (DM) is an increasingly prevalent cause of morbidity and mortality among U.S. adults, with increasing prevalence in emergency department (ED) visits. Multiple medications, such as exenatide, a glucagon-like peptide-1 agonist, have been developed in the past decade to combat this growing problem. This medication is well documented to cause gastrointestinal upset and skin nodules at the injection site. However, currently no documented cases exist regarding manipulation of injection nodules causing increased absorption or reports demonstrating an increase in adverse drug reactions. CASE REPORT: We report an interesting case of an adult male patient who likely experienced increased systemic absorption of exenatide by manipulating an injection nodule, which ultimately resulted in nausea, retching, diarrhea, and a tachycardic heart rate of 130-140 beats/min. These symptoms are known side effects of exenatide. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the high frequency of DM patients presenting to the ED, emergency physicians should be familiar with diabetic maintenance medications and their adverse reactions. Treating these side effects and properly educating patients can alleviate discomfort, prevent future adverse reactions, and decrease return visits to the ED.