A Case of Euglycemic Diabetic Ketoacidosis With Tirzepatide Use and Severe Calorie Restriction

We describe a case of euglycemic diabetic ketoacidosis (EDKA) in a 30-year-old man with no known diabetes on tirzepatide, intermittent fasting (IF), and a low-carbohydrate diet for weight loss. While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combined GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RAs), like tirzepatide, are effective for weight loss and diabetes management, their unsupervised use, especially alongside ketosis-inducing diets, may lead to serious risks such as EDKA. This report emphasizes the need for medical supervision in weight management, particularly when combining medications such as tirzepatide with dietary interventions, like IF and low-carbohydrate diets.