Starvation Ketoacidosis Secondary to Retatrutide-Induced Gastroparesis: A Case Report
https://doi.org/10.15605/jafes.041.S1
- Author:
Shinye Eng
1
;
Rabeah Md Zuki
1
Author Information
1. Medical Department, Hospital Sultan Abdul Halim
- Publication Type:Journal Article
- MeSH:
Gastroparesis;
Ketosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):63-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction
Retatrutide is an investigational triple agonist targeting
glucagon-like peptide-1, glucose-dependent insulinotropic
polypeptide, and glucagon receptors. Early clinical trials have demonstrated promising weight loss effects. Gastrointestinal side effects are common and dose-dependent;
however, severe complications such as gastroparesis leading
to starvation ketoacidosis are rarely reported. Increasing
public interest in emerging anti-obesity pharmacotherapies
has led to unsupervised access to investigational medications through unregulated channels. We report a case of
starvation ketoacidosis associated with retatrutide-induced
gastroparesis following unsupervised use of medication
obtained from unregulated sources.
Case:A 39-year-old female healthcare worker with prediabetes
(hemoglobin A1c 5.7%), class I obesity (body mass index
31.2 kg/m²), and endometriosis presented with persistent
vomiting and diarrhea. She reported using retatrutide for
weight loss, initially obtained from an informal source,
although the authenticity and origin of the medication
could not be verified. She self-titrated retatrutide over 7
weeks, escalating from 1 mg twice weekly to 6 mg weekly,
with only mild nausea. Subsequently, she purchased
the medication from another unverified online source.
Following this change, she developed worsening nausea at
the 6 mg weekly dose, prompting a dose reduction to 5 mg
weekly. Two days after the most recent dose, she developed
intractable vomiting and diarrhea. On presentation, she
was clinically dehydrated. Venous blood gas revealed
metabolic acidosis (pH 7.33, bicarbonate 18.8 mmol/L) with
elevated serum ketones (4.5 mmol/L) and normal lactate
(1.2 mmol/L). Blood glucose was 4.5 mmol/L, and serum
amylase was normal. She was treated with intravenous
fluids, fixed-rate insulin infusion, and antiemetics.
Ketoacidosis resolved by day 3, with improvement of
gastrointestinal symptoms by day 5.
Conclusion:This case highlights a serious complication associated with
retatrutide and underscores the risks of unsupervised use
of investigational weight-loss therapies obtained from
unregulated sources. It also emphasizes pharmacovigilance
as emerging antiobesity therapies become widely used.
Careful dose titration, close clinical monitoring, and
use within regulated medical channels are essential for
patient safety.
- Full text:2026080316273377624EP_A080.pdf
