Semaglutide · research summary

Severe Euglycemic Diabetic Ketoacidosis After Semaglutide-Associated Poor Intake Despite Empagliflozin Discontinuation: A Case Report.

International medical case reports journal · 2026. Summary drawn from the study's full text. Each statement is followed by the exact sentence it comes from. This is a research summary, not medical advice.

Study type

Case report
“This case report was prepared in accordance with the CARE guidelines.”

Subjects

A 68-year-old woman with long-standing type 2 diabetes
“A 68-year-old woman with a 17-year history of type 2 diabetes presented to the emergency department with acute shortness of breath, generalized weakness, slowed speech, disorientation, nausea, dry mouth, pruritus, and difficulty ambulating.”

Sample size

1
“We report severe EDKA after semaglutide-associated gastrointestinal intolerance in a patient with type 2 diabetes who had reportedly stopped long-term empagliflozin approximately two weeks before admission.”

Duration

Approximately three weeks of symptoms prior to presentation
“For approximately three weeks before admission, she had persistent nausea with intermittent vomiting and diarrhea, heartburn, poor appetite, and minimal food intake, primarily drinking water.”

Reported findings

The clinical presentation was temporally associated with semaglutide initiation and subsequent gastrointestinal intolerance leading to near-starvation.
“The temporal association is consistent with a clinically plausible contribution from semaglutide-associated gastrointestinal intolerance and carbohydrate depletion to EDKA despite reported prior empagliflozin discontinuation.”
The patient improved with intravenous crystalloid, dextrose-containing fluids, insulin infusion, and electrolyte replacement, with the anion gap closing and mental status returning to baseline.
“The anion gap closed with DKA protocol treatment, and her mental status returned to baseline without focal neurologic deficits.”

Limitations stated by the authors

Medication timing relied on patient and family reconciliation, beta-hydroxybutyrate was not repeated, and comprehensive toxicologic and endocrine evaluations were not documented.
“Medication timing relied partly on patient and family reconciliation, and the clinical record contained variable descriptions of when oral diabetes agents were stopped.”

Source: PubMed 42859665 · DOI 10.2147/IMCRJ.S650090 · all study summaries

Subjects

A 68-year-old woman with long-standing type 2 diabetes

“A 68-year-old woman with a 17-year history of type 2 diabetes presented to the emergency department with acute shortness of breath, generalized weakness, slowed speech, disorientation, nausea, dry mouth, pruritus, and difficulty ambulating.”

Reported findings

The clinical presentation was temporally associated with semaglutide initiation and subsequent gastrointestinal intolerance leading to near-starvation.

“The temporal association is consistent with a clinically plausible contribution from semaglutide-associated gastrointestinal intolerance and carbohydrate depletion to EDKA despite reported prior empagliflozin discontinuation.”

The patient improved with intravenous crystalloid, dextrose-containing fluids, insulin infusion, and electrolyte replacement, with the anion gap closing and mental status returning to baseline.

“The anion gap closed with DKA protocol treatment, and her mental status returned to baseline without focal neurologic deficits.”

Limitations stated by the authors

Medication timing relied on patient and family reconciliation, beta-hydroxybutyrate was not repeated, and comprehensive toxicologic and endocrine evaluations were not documented.

“Medication timing relied partly on patient and family reconciliation, and the clinical record contained variable descriptions of when oral diabetes agents were stopped.”