Euglycemic diabetic ketoacidosis following treatment with tirzepatide and SGLT-2 inhibitors: A case report and literature review

Tirzepatide is a novel antidiabetic agent with strong blood-glucose-lowering and body-weight-reducing effects. However, 14% of the patients treated with tirzepatide experienced appetite loss. The incidence of euglycemic diabetic ketoacidosis (EDKA) has recently increased with the heightened use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and the consequent appetite loss. Therefore, the temporary discontinuation of tirzepatide and SGLT-2 inhibitors is required under sick-day conditions. We herein report a case of EDKA that developed after the continuation of tirzepatide and SGLT-2 inhibitor on sick-day condition. After recovery from the sick-day condition, both agents were successfully reintroduced without any adverse effects.