Severe Euglycemic Ketoacidosis Secondary to Tirzepatide Use for Weight Loss.

Numerous reports have documented the incidence of euglycemic ketoacidosis as a complication of sodium-glucose cotransporter-2 (SGLT-2) inhibitors. However, euglycemic ketoacidosis secondary to the use of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists, such as tirzepatide, is becoming increasingly prevalent. While cases of euglycemic ketoacidosis in patients using tirzepatide managed with intravenous dextrose have been reported, this case describes a unique and severe presentation. We report a case of starvation-induced euglycemic ketoacidosis secondary to tirzepatide use resulting in transient neurological deficits, profound metabolic acidosis, and acute renal failure requiring intensive care admission and continuous renal replacement therapy. This report highlights the diagnostic challenges in patients presenting with altered levels of consciousness and an unclear clinical history, emphasizing the need for a high index of suspicion for ketoacidosis in patients on tirzepatide, even in the presence of normal blood glucose levels.