{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T11:45:18Z","timestamp":1788090318055,"version":"build-2803163510"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Euglycemic diabetic ketoacidosis (euDKA) is an uncommon but potentially life\u2010threatening complication that may arise in patients treated with incretin\u2010based therapies or Sodium\u2013Glucose Cotransporter\u20102 (SGLT2) inhibitors. We report a 41\u2010year\u2010old female with Type 1 Diabetes Mellitus (T1DM) who developed severe euDKA after initiating tirzepatide for weight loss while on empagliflozin and basal\u2013bolus insulin therapy. She presented with severe vomiting and profound metabolic acidosis (pH\u20096.96, bicarbonate 1.5\u2009mmol\/L) despite only modest hyperglycemia (glucose 190\u2013200\u2009mg\/dL). The severity of acidosis necessitated intubation and intravenous bicarbonate therapy. Laboratory findings revealed elevated amylase (688\u2009U\/L), suggesting possible tirzepatide\u2010associated pancreatic stress. No infection or other precipitating factor was identified. The patient recovered after intensive insulin and fluid replacement. This case highlights the risk of severe euDKA with the administration of tirzepatide in T1DM, particularly in combination with an SGLT2 inhibitor. Clinicians should keep a high index of suspicion for ketoacidosis in such patients despite normal or mildly elevated glucose levels and inform them of early detection of symptoms and sick day management.<\/jats:p>","DOI":"10.1002\/ccr3.71929","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T03:55:21Z","timestamp":1769140521000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Severe Euglycemic Diabetic Ketoacidosis Requiring Intubation After Tirzepatide and\n                    <scp>SGLT2<\/scp>\n                    Inhibitor Coadministration in a Patient With Type 1 Diabetes Mellitus From a Large Tertiary Care Centre in Karachi, Pakistan: A Case Report and Brief Review of the Literature"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3917-7761","authenticated-orcid":false,"given":"Maliha","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Medicine Liaquat National Hospital  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1602-2147","authenticated-orcid":false,"given":"Hammad","family":"Amjad","sequence":"additional","affiliation":[{"name":"Department of Medicine Karachi Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4565-5181","authenticated-orcid":false,"given":"Khadija","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Medicine Civil Hospital  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4557-5743","authenticated-orcid":false,"given":"Muddassir Syed","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Medicine Karachi Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5796-9132","authenticated-orcid":false,"given":"Shanzay","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Department of Medicine Karachi Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1505-2874","authenticated-orcid":false,"given":"Muslehuddin","family":"Paracha","sequence":"additional","affiliation":[{"name":"Department of Medicine Karachi Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1169-4507","authenticated-orcid":false,"given":"Mobeen","family":"Abid","sequence":"additional","affiliation":[{"name":"Department of Medicine Karachi Medical and Dental College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6619-3283","authenticated-orcid":false,"given":"Nabahat","family":"Shafi","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2930-8188","authenticated-orcid":false,"given":"Ahmed Asad","family":"Raza","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8614-3924","authenticated-orcid":false,"given":"Abedin","family":"Samadi","sequence":"additional","affiliation":[{"name":"Department of Medicine Kabul University of Medical Sciences Abu Ali Sina  Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samar Abbas","family":"Jaffri","sequence":"additional","affiliation":[{"name":"Department of Medicine Liaquat National Hospital  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5866.578"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2019.03.014"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0843"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcemcr\/luae156"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2206038"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592\u2010025\u201002535\u2010x"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcemcr\/luaf028"},{"key":"e_1_2_16_9_1","unstructured":"U.Hussain M.Al\u2010Hail W.Al\u2010Fahaidi andM.Faisal \u201cTirzepatide\u2014Induced Diabetic Ketoacidosis in a Patient With Type 1 Diabetes: A Case Report \u201d(2025) accessed October 24 2025 https:\/\/www.authorea.com\/users\/914291\/articles\/1287436\u2010tirzepatide\u2010induced\u2010diabetic\u2010ketoacidosis\u2010in\u2010a\u2010patient\u2010with\u2010type\u20101\u2010diabetes\u2010a\u2010case\u2010report?commit=6703dd48784bd01a15326279eb1bf0934c922c51."},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/postmj\/qgaf079"},{"key":"e_1_2_16_11_1","article-title":"When the Transition Goes Wrong: A Rare Case of Diabetic Ketoalkalosis After Transitioning to Tirzepatide in Insulin\u2010Dependent Type 2 Diabetes","volume":"17","author":"Sultan W.","year":"2025","journal-title":"Cureus"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40200-024-01430-6"},{"issue":"4","key":"e_1_2_16_13_1","first-page":"116","article-title":"Diabetic Ketoacidosis in a Patient With Type I Diabetes Treated With a Closed\u2010Loop Sensor\u2013Augmented Insulin Infusion System","volume":"9","author":"Sharma P. 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