Case report links tirzepatide dose escalation to lactic acidosis and euglycemic DKA

The wire

1. 01Clinicians describe concurrent metformin-associated lactic acidosis and euglycemic diabetic ketoacidosis in a woman with type 2 diabetes who ate little for two weeks after tirzepatide escalation; she required intubation, vasopressors and continuous renal replacement therapy.
2. 02The authors attribute the picture to starvation ketosis plus dehydration and acute kidney injury impairing metformin clearance, a combination relevant when incretin therapy continues through prolonged poor intake.
3. 03She improved rapidly after metformin and tirzepatide were stopped; this is a single case report and cannot establish incidence or causation.

From the source

Concurrent metformin-associated lactic acidosis and euglycemic diabetic ketoacidosis from tirzepatide starvation ketosis

Endocrinology, diabetes & metabolism case reports · 2026 Jul 1 · Epitropoulos F, Brijawi O, Ghuman K et al.