{"id":"https://openalex.org/W7136209508","doi":"https://doi.org/10.1186/s12245-026-01170-9","title":"Starvation ketoacidosis associated with tirzepatide use for weight loss in a non-diabetic East Asian woman: a case report","display_name":"Starvation ketoacidosis associated with tirzepatide use for weight loss in a non-diabetic East Asian woman: a case report","publication_year":2026,"publication_date":"2026-03-16","ids":{"openalex":"https://openalex.org/W7136209508","doi":"https://doi.org/10.1186/s12245-026-01170-9","pmid":"https://pubmed.ncbi.nlm.nih.gov/41840480","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13104288"},"language":"en","primary_location":{"id":"doi:10.1186/s12245-026-01170-9","doi":"https://doi.org/10.1186/s12245-026-01170-9","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12245-026-01170-9","pdf_url":null,"source":{"id":"https://openalex.org/S105925683","display_name":"International Journal of Emergency Medicine","issn_l":"1865-1372","issn":["1865-1372","1865-1380"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1","oarl","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International Journal of Emergency Medicine","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1186/s12245-026-01170-9","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5129473878","display_name":"Yuki Minoda","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Yuki Minoda","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan. 14.yukki1029@gmail.com"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan. 14.yukki1029@gmail.com","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5082103856","display_name":"Syuhei Ikeda","orcid":"https://orcid.org/0000-0002-4527-5601","observed_orcids":["https://orcid.org/0000-0002-4527-5601"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Syuhei Ikeda","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014230013","display_name":"Koichi Inukai","orcid":"https://orcid.org/0000-0003-0881-698X","observed_orcids":["https://orcid.org/0000-0003-0881-698X"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Koichi Inukai","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5123853437","display_name":"Suguru Kishitani","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Suguru Kishitani","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5123878681","display_name":"Takamasa Takeuchi","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Takamasa Takeuchi","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5013721781","display_name":"Hirohiko Aikawa","orcid":"https://orcid.org/0000-0001-6392-8381","observed_orcids":["https://orcid.org/0000-0001-6392-8381"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Hirohiko Aikawa","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5076142771","display_name":"Ken Saito","orcid":"https://orcid.org/0000-0001-5756-2512","observed_orcids":["https://orcid.org/0000-0001-5756-2512"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ken Saito","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5075894679","display_name":"Hirotada Kittaka","orcid":"https://orcid.org/0000-0003-3766-3919","observed_orcids":["https://orcid.org/0000-0003-3766-3919"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Hirotada Kittaka","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5031936230","display_name":"Yasuyuki Hayashi","orcid":"https://orcid.org/0000-0002-3294-4706","observed_orcids":["https://orcid.org/0000-0002-3294-4706","https://orcid.org/0009-0003-7126-6842"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Yasuyuki Hayashi","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5044421220","display_name":"Hirotaka Sawano","orcid":"https://orcid.org/0000-0002-2876-7276","observed_orcids":["https://orcid.org/0000-0002-2876-7276"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Hirotaka Sawano","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5129497177","display_name":"Yusuke Ito","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Yusuke Ito","raw_affiliation_strings":["Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka, Japan","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5129473878"],"corresponding_institution_ids":[],"apc_list":{"value":3090,"currency":"USD","value_usd":3090},"apc_paid":{"value":3090,"currency":"USD","value_usd":3090},"fwci":10.3304,"has_fulltext":true,"cited_by_count":4,"citation_normalized_percentile":{"value":0.97886792,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":97,"max":98},"biblio":{"volume":"19","issue":"1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12539","display_name":"Pharmacology and Obesity Treatment","score":0.6147000193595886,"subfield":{"id":"https://openalex.org/subfields/2736","display_name":"Pharmacology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12539","display_name":"Pharmacology and Obesity Treatment","score":0.6147000193595886,"subfield":{"id":"https://openalex.org/subfields/2736","display_name":"Pharmacology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12267","display_name":"Diet and metabolism studies","score":0.2782999873161316,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10401","display_name":"Diabetes Treatment and Management","score":0.019300000742077827,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/starvation-ketoacidosis","display_name":"starvation ketoacidosis","score":0.9570000171661377},{"id":"https://openalex.org/keywords/tirzepatide","display_name":"tirzepatide","score":1.0},{"id":"https://openalex.org/keywords/obesity","display_name":"obesity","score":0.45899999141693115},{"id":"https://openalex.org/keywords/weight-loss","display_name":"weight loss","score":0.828000009059906},{"id":"https://openalex.org/keywords/non-diabetic-patients","display_name":"non-diabetic patients","score":0.7960000038146973},{"id":"https://openalex.org/keywords/high-anion-gap-metabolic-acidosis","display_name":"high anion gap metabolic acidosis","score":0.8339999914169312},{"id":"https://openalex.org/keywords/hypoglycemia","display_name":"hypoglycemia","score":0.890999972820282},{"id":"https://openalex.org/keywords/ketonuria","display_name":"ketonuria","score":0.8960000276565552},{"id":"https://openalex.org/keywords/glucose-dependent-insulinotropic-polypeptide","display_name":"glucose-dependent insulinotropic polypeptide","score":0.765999972820282},{"id":"https://openalex.org/keywords/glp-1-receptor-agonists","display_name":"GLP-1 receptor agonists","score":0.984000027179718},{"id":"https://openalex.org/keywords/carbohydrate-restriction","display_name":"carbohydrate restriction","score":0.800000011920929},{"id":"https://openalex.org/keywords/caloric-deprivation","display_name":"caloric deprivation","score":0.6330000162124634},{"id":"https://openalex.org/keywords/east-asian-patients","display_name":"East Asian patients","score":0.5249999761581421}],"concepts":[{"id":"https://openalex.org/C2780606744","wikidata":"https://www.wikidata.org/wiki/Q853930","display_name":"Starvation","level":2,"score":0.8831999897956848},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8144999742507935},{"id":"https://openalex.org/C544821477","wikidata":"https://www.wikidata.org/wiki/Q718113","display_name":"Weight loss","level":3,"score":0.7402999997138977},{"id":"https://openalex.org/C2779246250","wikidata":"https://www.wikidata.org/wiki/Q1598200","display_name":"Metabolic acidosis","level":2,"score":0.7296000123023987},{"id":"https://openalex.org/C2775849729","wikidata":"https://www.wikidata.org/wiki/Q1130148","display_name":"Ketoacidosis","level":4,"score":0.652400016784668},{"id":"https://openalex.org/C2780668416","wikidata":"https://www.wikidata.org/wiki/Q202758","display_name":"Hypoglycemia","level":3,"score":0.5888000130653381},{"id":"https://openalex.org/C2781283889","wikidata":"https://www.wikidata.org/wiki/Q1130148","display_name":"Diabetic ketoacidosis","level":3,"score":0.5666000247001648},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.46650001406669617},{"id":"https://openalex.org/C134018914","wikidata":"https://www.wikidata.org/wiki/Q162606","display_name":"Endocrinology","level":1,"score":0.43459999561309814},{"id":"https://openalex.org/C2778553927","wikidata":"https://www.wikidata.org/wiki/Q185089","display_name":"Acidosis","level":2,"score":0.4262000024318695},{"id":"https://openalex.org/C2779306644","wikidata":"https://www.wikidata.org/wiki/Q2002370","display_name":"Insulin","level":2,"score":0.400299996137619},{"id":"https://openalex.org/C2776731943","wikidata":"https://www.wikidata.org/wiki/Q1123139","display_name":"Ketosis","level":3,"score":0.37549999356269836},{"id":"https://openalex.org/C31532488","wikidata":"https://www.wikidata.org/wiki/Q746183","display_name":"Ketone bodies","level":3,"score":0.3544999957084656},{"id":"https://openalex.org/C138463869","wikidata":"https://www.wikidata.org/wiki/Q14901436","display_name":"Starvation response","level":3,"score":0.34850001335144043},{"id":"https://openalex.org/C42407357","wikidata":"https://www.wikidata.org/wiki/Q521","display_name":"Physiology","level":1,"score":0.3481000065803528},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.3449000120162964},{"id":"https://openalex.org/C2778573388","wikidata":"https://www.wikidata.org/wiki/Q1641384","display_name":"Hypophosphatemia","level":2,"score":0.3222000002861023},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.30730000138282776},{"id":"https://openalex.org/C511355011","wikidata":"https://www.wikidata.org/wiki/Q12174","display_name":"Obesity","level":2,"score":0.30410000681877136},{"id":"https://openalex.org/C2777735490","wikidata":"https://www.wikidata.org/wiki/Q2351083","display_name":"Metabolic disorder","level":2,"score":0.28859999775886536},{"id":"https://openalex.org/C2780580376","wikidata":"https://www.wikidata.org/wiki/Q186889","display_name":"Nausea","level":2,"score":0.27480000257492065},{"id":"https://openalex.org/C2777299393","wikidata":"https://www.wikidata.org/wiki/Q548646","display_name":"Anion gap","level":3,"score":0.27230000495910645},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.26910001039505005},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.26570001244544983}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1186/s12245-026-01170-9","doi":"https://doi.org/10.1186/s12245-026-01170-9","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12245-026-01170-9","pdf_url":null,"source":{"id":"https://openalex.org/S105925683","display_name":"International Journal of Emergency Medicine","issn_l":"1865-1372","issn":["1865-1372","1865-1380"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1","oarl","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International Journal of Emergency Medicine","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13104288","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13104288/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13104288/pdf/12245_2026_Article_1170.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Int J Emerg Med","raw_type":"Text"},{"id":"pmid:41840480","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41840480","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International journal of emergency medicine","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:cae6389baed345bcb1b281b2aec1d6a2","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/cae6389baed345bcb1b281b2aec1d6a2","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"International Journal of Emergency Medicine, Vol 19, Iss 1 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1186/s12245-026-01170-9","doi":"https://doi.org/10.1186/s12245-026-01170-9","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12245-026-01170-9","pdf_url":null,"source":{"id":"https://openalex.org/S105925683","display_name":"International Journal of Emergency Medicine","issn_l":"1865-1372","issn":["1865-1372","1865-1380"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","jufo-1","ki-jl-1","norway-1","oarl","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International Journal of Emergency Medicine","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":1.0}],"study_designs":[{"id":"https://openalex.org/study-designs/case-report","display_name":"Case Report"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7136209508.pdf","grobid_xml":"https://content.openalex.org/works/W7136209508.grobid-xml"},"referenced_works_count":14,"referenced_works":["https://openalex.org/W2122708329","https://openalex.org/W3108676144","https://openalex.org/W3177122952","https://openalex.org/W4285818288","https://openalex.org/W4388489830","https://openalex.org/W4392641675","https://openalex.org/W4402072375","https://openalex.org/W4403024620","https://openalex.org/W4404121138","https://openalex.org/W4404263882","https://openalex.org/W4406955162","https://openalex.org/W4408670622","https://openalex.org/W4409417156","https://openalex.org/W4409920814"],"related_works":["https://openalex.org/W7161823195","https://openalex.org/W4404263882","https://openalex.org/W4392641675","https://openalex.org/W7153627343","https://openalex.org/W7171175292","https://openalex.org/W7214315463","https://openalex.org/W7171860724","https://openalex.org/W4415474401","https://openalex.org/W7167520669","https://openalex.org/W4388489830"],"abstract_inverted_index":{"BACKGROUND:":[0],"Tirzepatide,":[1],"a":[2,26],"dual":[3],"glucose-dependent":[4],"insulinotropic":[5],"polypeptide":[6],"and":[7,36,49,87,105,123,239,245],"glucagon-like":[8],"peptide-1":[9],"receptor":[10],"agonist,":[11],"is":[12,25],"increasingly":[13],"used":[14],"for":[15,72,213,224,262],"obesity":[16,65],"treatment,":[17],"including":[18],"in":[19,44,54,162,184,204,220,246],"individuals":[20],"without":[21,171,260],"diabetes.":[22],"Starvation":[23,152],"ketoacidosis":[24,43,153,183,219],"rare":[27],"but":[28],"serious":[29],"complication":[30],"associated":[31],"with":[32,64,101,157,229,248],"reduced":[33,92],"caloric":[34,197],"intake":[35],"enhanced":[37],"ketogenesis.":[38],"Reports":[39],"of":[40,140,165],"tirzepatide-associated":[41],"starvation":[42,182,218],"non-diabetic":[45,185],"patients":[46,221,247],"remain":[47],"limited,":[48],"none":[50],"have":[51],"been":[52],"reported":[53,202],"East":[55,206],"Asian":[56,207],"populations.":[57],"CASE":[58],"PRESENTATION:":[59],"A":[60],"21-year-old":[61],"Japanese":[62],"woman":[63],"initiated":[66],"weekly":[67],"subcutaneous":[68],"tirzepatide":[69,179,223],"(2.5":[70],"mg/week)":[71],"weight":[73,225,235],"loss":[74,226],"while":[75],"practicing":[76],"carbohydrate":[77],"restriction.":[78],"After":[79],"the":[80,98,138,200,211],"fifth":[81],"injection,":[82],"she":[83],"developed":[84],"persistent":[85],"nausea":[86],"vomiting,":[88,230],"leading":[89],"to":[90,97,196,216],"markedly":[91,128],"oral":[93],"intake.":[94],"She":[95,130],"presented":[96],"emergency":[99,214],"department":[100],"hypoglycemia":[102],"(68":[103],"mg/dL)":[104],"severe":[106],"high-anion":[107],"gap":[108,117],"metabolic":[109,148,166,241],"acidosis":[110,167],"(pH":[111],"7.22,":[112],"bicarbonate":[113],"10":[114],"mmol/L,":[115],"anion":[116],"22.6":[118],"mmol/L).":[119],"Urinalysis":[120],"revealed":[121],"ketonuria,":[122],"serum":[124],"ketone":[125],"levels":[126],"were":[127],"elevated.":[129],"had":[131],"lost":[132],"21":[133],"kg":[134],"one":[135],"month":[136],"after":[137],"initiation":[139],"tirzepatide.":[141],"No":[142],"infection,":[143],"toxin":[144],"exposure,":[145],"or":[146,192,233],"alternative":[147],"disorder":[149],"was":[150,154],"identified.":[151],"diagnosed.":[155],"Treatment":[156],"intravenous":[158],"glucose-containing":[159],"fluids":[160],"resulted":[161],"rapid":[163,234,258],"resolution":[164],"within":[168],"12":[169],"h":[170],"insulin":[172,251,263],"therapy.":[173,264],"CONCLUSIONS:":[174],"This":[175],"case":[176,203],"demonstrates":[177],"that":[178],"can":[180],"precipitate":[181],"individuals,":[186],"particularly":[187],"when":[188],"gastrointestinal":[189],"adverse":[190],"effects":[191],"dietary":[193],"restriction":[194],"lead":[195],"deprivation.":[198],"As":[199],"first":[201],"an":[205],"patient,":[208],"it":[209],"highlights":[210],"need":[212,261],"physicians":[215],"consider":[217],"using":[222],"who":[227],"present":[228],"poor":[231],"intake,":[232],"loss.":[236],"Early":[237],"recognition":[238],"appropriate":[240],"assessment":[242],"are":[243],"essential,":[244],"preserved":[249],"endogenous":[250],"secretion,":[252],"prompt":[253],"glucose":[254],"administration":[255],"may":[256],"allow":[257],"recovery":[259]},"counts_by_year":[{"year":2026,"cited_by_count":4}],"updated_date":"2026-11-10T11:39:43.021295","created_date":"2026-03-17T00:00:00"}