Tirzepatide-Related Acute Liver Injury.

Tirzepatide, a modified protein containing 39 amino acids, acts as a dual agonist at the gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, showing great promise in weight-loss treatment. While rare, there have been reports of hepatotoxicity associated with tirzepatide use, and the exact mechanism of liver injury remains unclear. This case report highlights the experience of a 24-year-old female schoolteacher who started her weight-loss journey with tirzepatide. Despite its potential, she developed an idiosyncratic drug-related liver injury after escalating doses of tirzepatide prescribed by a private doctor. Her symptoms of recurrent vomiting, nausea and abdominal pain, initially indicative of hypoglycaemia and mild metabolic disturbances, ultimately revealed acute hepatitis and impaired coagulopathy. This case underscores the need for further research and frequent following of liver enzymes when using tirzepatide for weight loss.

Learning points: Tirzepatide should be used cautiously, with regular monitoring of liver function tests.If patients develop severe gastrointestinal symptoms or worsening abdominal pain, immediate hospital admission is necessary for further work-up, including a CT abdomen.Daily liver function tests, renal function tests and international normalised ratio (INR) tests should be conducted to identify and manage potential complications.