First Report of Semaglutide-Induced Euglycemic Ketoacidosis in a Non-Diabetic Patient
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- First reported case This 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
- Evidence Grade:
- Preliminary — single case report. While clinically important for safety awareness, case reports cannot establish incidence rates or definitive causation.
- Study Age:
- Published in 2024, an important early safety signal as off-label and approved weight-loss use of semaglutide rapidly expands.
- Original Title:
- Euglycemic Ketoacidosis From Semaglutide in a Patient Without Diabetes.
- Published In:
- JCEM case reports, 2(9), luae156 (2024)
- Authors:
- Sood, Nikhil, Bansal, Ojas, Garg, Rohini, Hoskote, Abhinav
- Database ID:
- RPEP-09307
Evidence Hierarchy
Frequently Asked Questions
What is euglycemic ketoacidosis?
Normally, ketoacidosis occurs with very high blood sugar in diabetic patients. In euglycemic ketoacidosis, blood sugar is normal but the body is still producing dangerous levels of ketones, making the blood acidic. This is tricky because the normal blood sugar can delay diagnosis — doctors may not think to check for ketones if glucose looks fine.
Should I stop taking semaglutide for weight loss?
No — this is an extremely rare event, and semaglutide's benefits are well-established. However, be aware of warning signs: unusual nausea or vomiting (beyond the typical GLP-1 side effects), abdominal pain, rapid or deep breathing, or feeling unusually unwell. These warrant immediate medical attention, especially if you're eating very little.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-09307APA
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
MLA
Sood, Nikhil, et al. "Euglycemic Ketoacidosis From Semaglutide in a Patient Without Diabetes.." JCEM case reports, 2024. https://doi.org/10.1210/jcemcr/luae156
RethinkPeptides
RethinkPeptides Research Database. "Euglycemic Ketoacidosis From Semaglutide in a Patient Withou..." RPEP-09307. Retrieved from https://rethinkpeptides.com/research/sood-2024-euglycemic-ketoacidosis-from-semaglutide
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Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.