Non-diabetic woman develops euglycemic ketoacidosis from tirzepatide obtained via online prescription | Research

The takeaway

A 48-year-old non-diabetic woman developed euglycemic ketoacidosis after 6 weeks of tirzepatide from an online prescription, presenting with dehydration, pH 7.2, normal glucose, and elevated ketones.

EKA in non-diabetic
Tirzepatide caused euglycemic ketoacidosis in a non-diabetic woman with normal blood sugar (pH 7.2)—expanding the known risk population and highlighting online prescribing dangers

What the researchers found

Non-diabetic woman, BMI 30.4, online prescription tirzepatide. Self-titrated to 5 mg over 6 weeks. Lost 16 lbs. Developed EKA: pH 7.2, bicarb 17, elevated ketones, normal glucose. Recovered with fluids.

Why it matters

This is a non-diabetic EKA case—expanding the known risk population beyond diabetics. The online prescription pathway highlights the growing danger of unsupervised GLP-1 drug access.

How the study worked

Single case report with clinical presentation and management.

What this study cannot tell us

Single case. Causation assumed but other factors may have contributed. Non-diabetic EKA is very rare. Online prescribing context may not be representative.

How to read the evidence

Single case report. Important for safety awareness but cannot establish incidence.

When this study was published

Published in 2025.

The bigger picture

This case, combined with similar reports, establishes that GLP-1/GIP drugs can cause metabolic emergencies in non-diabetic patients—a population increasingly accessing these drugs through online and telehealth channels.

Questions still open

What is the true incidence of EKA in non-diabetic GLP-1 users?
Should online GLP-1 prescriptions require metabolic monitoring?
Are caloric restriction and dehydration the primary EKA triggers in non-diabetics?

Common questions

Can weight loss drugs cause ketoacidosis even without diabetes?

Yes, as this case shows. Tirzepatide caused euglycemic ketoacidosis (dangerous acid buildup with normal blood sugar) in a non-diabetic woman. The combination of drug-induced appetite suppression, caloric restriction, and dehydration likely triggered the metabolic emergency.

Is it safe to get GLP-1 drugs from online prescriptions?

This case raises serious concerns. The patient obtained tirzepatide through an online prescription and self-titrated without adequate medical monitoring. Without proper supervision, potentially life-threatening complications like ketoacidosis can be missed. Medical oversight and regular lab monitoring are essential.

Read the original research

Euglycemic Ketoacidosis in a Non-diabetic Patient After Tirzepatide Use: A Cautionary Tale.

Cureus, 17(4), e83187

View on PubMed ↗Publisher’s paper ↗

Citation

Singh, Renisha. (2025). Euglycemic Ketoacidosis in a Non-diabetic Patient After Tirzepatide Use: A Cautionary Tale.. Cureus, 17(4), e83187. https://doi.org/10.7759/cureus.83187