Acute pancreatitis and euglycemic non-diabetic ketoacidosis caused by an intentional semaglutide overdose

Abstract

Background

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have been approved for weight loss and have gained popularity for its efficacy and a once-weekly administration. The FDA approved max dose of 2.4 mg per week resulted in a 10 % reduction in weight over a 6-month period. GLP receptors are expressed in islet and exocrine duct cells of the pancreas. Case reports of pancreatitis and diabetic ketoacidosis have been reported in patients who have hypertriglyceridemia or carry a diagnosis of diabetes.

Case report

We report a first-of-its kind case of an intentional overdose of semaglutide leading to pancreatitis and ultimately euglycemic non-diabetic ketoacidosis (EnDKA). Overstimulation by GLP-1 agonists, like semaglutide, can lead to hyperplasia and resulting pancreatitis. Acute pancreatitis can induce a systemic inflammatory response and may be responsible for dysfunction of beta cells and subsequent insulin deficiency, resulting in diabetic ketoacidosis.

Why should an EM Physician be aware of this?

Acute pancreatitis and euglycemic non-diabetic ketoacidosis are both life threatening emergencies. As the use of weight-management drugs become increasingly popular, the incidence of these emergencies may be on the rise as well.