Euglycemic Ketoacidosis Following the Use of Counterfeit Semaglutide for Weight Loss.
This case report describes an 18-year-old woman with no prior medical history who developed euglycemic ketoacidosis (EKA) in association with self-administered semaglutide purchased online without medical supervision. After initiating the medication ten days prior and self-escalating doses, she presented with three days of nausea, intractable vomiting, and reduced oral intake. Laboratory findings revealed a high-anion gap metabolic acidosis (pH 7.24, bicarbonate 14 mmol/L, anion gap 24 mEq/L), markedly elevated β-hydroxybutyrate (5.9 mmol/L), and normal blood glucose (60 mg/dL), meeting criteria for EKA. She was treated with intravenous fluids, dextrose infusion, and supportive care, with clinical recovery and discharge within 36 hours. The authors propose that reduced oral intake combined with GLP-1 receptor agonist-induced gastrointestinal side effects may have triggered a starvation-like ketogenic state. Key limitations include the single-patient design, inability to verify the authenticity or exact composition of the online-purchased product, and lack of confirmed dosing history. The case raises awareness of EKA as a potential complication of GLP-1 receptor agonist use, particularly in unsupervised, non-diabetic individuals using unregulated sources.
Why this grade: A single case report in one human patient provides only limited human evidence; no control group, no dosing verification, and the product authenticity was unconfirmed.
Euglycemic ketoacidosis is a rare but increasingly recognized adverse effect related to the use of glucagon-like peptide-1 (GLP-1) receptor agonists. Reduced oral intake in combination with gastrointestinal side effects can trigger a starvation state and ketone body formation. The growing off-label use of glucagon-like peptide-1 (GLP-1) agents for weight loss, particularly without medical supervision, may further increase the risk of this serious complication. An 18-year-old woman with no medical history presented with persistent nausea, intractable vomiting, and reduced oral intake for three days. Ten days earlier, she had initiated semaglutide purchased online and self-administered escalating doses without supervision. Laboratory evaluation revealed high-anion gap metabolic acidosis (pH 7.24, bicarbonate 14 mmol/L, anion gap 24 mEq/L), markedly elevated β-hydroxybutyrate (5.9 mmol/L), and normoglycemia (60 mg/dL), consistent with euglycemic ketoacidosis. She improved rapidly with intravenous fluids, dextrose infusion, and supportive therapy and was discharged in stable condition after 36 hours. This case highlights an uncommon but serious adverse condition observed in association with semaglutide use in a non-diabetic patient. Contributing factors include possible inappropriate high-dose initiation and uncertainties in dosing and purity related to unregulated online products. Clinicians should be aware of euglycemic ketoacidosis as a potential complication of GLP-1 receptor agonists, particularly when obtained through unsafe sources and used without proper medical monitoring.
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