A young woman without diabetes developed life-threatening euglycemic ketoacidosis after 7 months of semaglutide use for weight loss — the first such case reported with semaglutide alone.
First reported caseThis is the first known case of semaglutide-induced euglycemic ketoacidosis in a non-diabetic patient — a life-threatening condition that can be missed because blood sugar remains normal
What the researchers found
First reported case of euglycemic ketoacidosis caused by semaglutide in a patient without diabetes. The patient presented with metabolic acidosis and ketonemia with normal blood glucose after 7 months of semaglutide for weight loss. Treatment with bicarbonate-containing dextrose infusion resolved the ketoacidosis rapidly.
Why it matters
Millions of non-diabetic patients are now taking semaglutide for weight loss. Euglycemic ketoacidosis is life-threatening and easily missed because blood sugar is normal — clinicians may not think to check for it. As GLP-1 prescribing continues to expand, recognizing this rare but serious complication could save lives.
The numbers in context
Patient used semaglutide for 7 months for weight loss. She had no history of diabetes. Presented with metabolic acidosis and ketonemia with normal blood glucose.
How the study worked
Single case report with literature review identifying only one prior case of GLP-1-related euglycemic ketoacidosis in a non-diabetic patient (with tirzepatide). Clinical presentation, lab findings, treatment, and outcome documented.
Who was studied
Non-diabetic young woman using semaglutide for weight loss
What this study cannot tell us
Single case report — cannot establish causation definitively. Other contributing factors (fasting, low-carb diet, alcohol use, exercise patterns) may have played a role alongside semaglutide. The mechanism by which GLP-1 agonists might cause ketoacidosis in non-diabetic patients is not well understood.
How to read the evidence
Preliminary — single case report. While clinically important for safety awareness, case reports cannot establish incidence rates or definitive causation.
When this study was published
Published in 2024, an important early safety signal as off-label and approved weight-loss use of semaglutide rapidly expands.
The bigger picture
The explosion of GLP-1 receptor agonist use for weight loss means these drugs are being taken by a much broader population than they were originally designed for. Rare adverse effects that might have been statistically invisible in clinical trials involving thousands of diabetic patients are now emerging as millions of non-diabetic patients use these drugs. This case highlights the need for ongoing pharmacovigilance.
Questions still open
- What is the mechanism by which semaglutide could trigger ketoacidosis in a non-diabetic patient?
- Are patients on very low-calorie diets while taking semaglutide at higher risk for euglycemic ketoacidosis?
Common questions
What is euglycemic ketoacidosis?
Should I stop taking semaglutide for weight loss?
Read the original research
Euglycemic Ketoacidosis From Semaglutide in a Patient Without Diabetes.
JCEM case reports, 2(9), luae156
Citation
Sood, Nikhil; Bansal, Ojas; Garg, Rohini; Hoskote, Abhinav. (2024). Euglycemic Ketoacidosis From Semaglutide in a Patient Without Diabetes.. JCEM case reports, 2(9), luae156. https://doi.org/10.1210/jcemcr/luae156