P4042 - The Risks of the New Weight Loss Medications

Mark Peicher, DO, Oscar Borja Montes, MD, Rahul Shekhar, MD
University of New Mexico, Albuquerque, NM

Introduction: Multiple factors such as socioeconomic status, metabolic comorbidities and adherence to non-pharmacological treatments have contributed to the rising rates of obesity. Tirzepatide is a novel GIP and GLP-1 agonist. Multiple studies have demonstrated its effectiveness in weight loss and hemoglobin A1C reduction. We present the first case report of Tirzepatide-induced intestinal ischemia in a patient with obesity and Type 2 diabetes mellitus.

Case Description/Methods: 45-year-old male with a history of prediabetes (A1C of 6.3), obesity class III (BMI 40.7) who presented for 5 days of watery diarrhea and right upper quadrant abdominal pain for 4 days. Patient denied any sick contacts or previous episodes. He states that he was started on Tirzepatide (Mounjaro), by his primary care physician for prediabetes and obesity, 1 week prior to presentation. Patient's only other home medications were Ondansetron and Olmesartan–Hydrochlorothiazide. He states that the day prior to presentation he had fish tacos for dinner with his wife. His wife did not have similar symptoms.

On presentation to the emergency department, patient was afebrile, blood pressure 80s/40s, heart rate 110s, cbc was unremarkable, potassium of 3.2, creatinine of 1.35, lactate of 5.10. CT chest/abdomen/pelvis angiogram with features of enterocolitis and distal wall esophageal wall thickening.



Patient was given 4 liters of lactated ringers without improvement and placed on Levophed, repeat CT abdomen/pelvis with contrast which demonstrated concern for ischemia of the gastric fundus and/or jejunum. Portal venous gas and small volume pelvic free fluid, without perforation.



General surgery and Gastroenterology were consulted for gastric pneumatosis and pneumobilia who recommended serial abdominal exams and lactates every 6 hours, empiric antibiotics, and no plan for urgent surgical or endoscopic intervention. Patient was initiated on piperacillin/tazobactam for empiric intrabdominal coverage.



Stool studies sent for c.diff, culture, ova and parasites, pathogens, H.pylori, E.histolytica, cryptosporidium, giardia were all negative. Patient was ultimately discharged and recommended to discontinue Tirzepatide (Mounjaro).

Discussion: Patients are frequently counseled on the known side effects of these medications with pancreatitis being the most serious and abdominal discomfort, diarrhea, nausea and vomiting being the most common. As these classes of medications become more frequently prescribed, inevitably we will encounter new adverse events.


Disclosures:


Mark Peicher, DO, Oscar Borja Montes, MD, Rahul Shekhar, MD. P4042 - The Risks of the New Weight Loss Medications, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.