Genital tuberculosis and endometriosis coexisting in an infertile female

Hypoglycemic Ketoacidosis in Nondiabetic Patients on Tirzepatide Tirzepatide (Mounjaro) is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 receptor agonist approved for the treatment of type 2 diabetes mellitus and obesity. Gastrointestinal adverse events are the most common and typically self-limiting; severe metabolic complications are uncommon. We describe four cases of hypoglycemic ketoacidosis following unsupervised, over-the-counter use of tirzepatide for weight reduction in nondiabetic women from Northern India. The patients, aged 27–33 years (body mass inde × 30.8–32 kg/m2), developed abdominal pain, vomiting, and diarrhea after escalating the dose to 5 mg subcutaneously by the 5th week of treatment. All required inpatient management with intravenous fluid resuscitation and correction of hypoglycemia and ketosis. This case series underscores the potential for serious metabolic derangements, including hypoglycemic ketoacidosis, associated with inappropriate tirzepatide use in nondiabetic individuals. Strict medical supervision and regulatory control are essential to ensure the safe and judicious use of this potent incretin-based therapy.