Glucose-dependent Insulinotropic Polypeptides (GIP)/Glucagon-like peptide-1(GLP-1) receptor agonists, such as Tirzepatide, work by increasing insulin secretion after oral glucose load. However, they also delay gastric emptying, reduce appetite, and inhibit glucagon production from pancreatic alpha-cells [5]. Additionally, evidence points towards the occurrence of nausea, vomiting, and diarrhea as adverse events in clinical trials studying GLP-1 agonists, more so in patients on Metformin [6]. The combination of the mechanism of action of Tirzepatide along with possible adverse effects demonstrate that it can put patients at risk of developing euglycemic ketoacidosis. Additionally, in this patient’s case, the use of Metformin for DM2 may have potentially exacerbated the acidosis due to its link to raised lactate levels in acute illness [7]
