Online-Sourced Retatrutide Complicating Impending Diabetic Ketoacidosis in a Patient With Type 1 Diabetes and Concurrent Shigella Gastroenteritis
Abstract
Growing public interest in incretin-based therapies for weight loss has been accompanied by increasing availability of research peptides purchasable online. Products may be used without medical assessment or counselling regarding adverse effects, sick-day management or appropriate follow-up. In addition, composition, purity and dosing accuracy may be uncertain. Retatrutide is a novel triple agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1 and glucagon receptors currently being investigated for obesity and type 2 diabetes mellitus, but has no established role in type 1 diabetes mellitus. We report a man in his mid-30s with longstanding type 1 diabetes mellitus who presented with severe vomiting, diarrhoea, hyperglycaemia, ketonaemia and acute kidney injury shortly after self-administering an online-purchased product marketed as retatrutide for weight loss. His partner, who had taken the same preparation, also developed gastrointestinal symptoms. Both had also consumed a potential foodborne source of infection. In type 1 diabetes mellitus, where patients remain dependent on exogenous insulin to suppress ketogenesis, gastrointestinal illness may rapidly precipitate ketosis when insulin is omitted and oral intake is reduced. Although diabetic ketoacidosis did not develop, peak ketonaemia reached 4.3 mmol/L in the setting of dehydration and insulin omission, requiring intravenous insulin and fluid replacement. During recovery, recurrent…
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