By Inflame 
Case Study: 24-Year-Old on Tirzepatide Develops Acute Liver Injury
Kuwait, November 28, 2024 – A recent case report in the European Journal of Case Reports in Internal Medicinehighlights the potential risk of liver injury associated with tirzepatide, a popular medication for weight loss. The findings underline the need for healthcare practitioners to exercise caution and prioritize monitoring when prescribing this treatment.
The report details the case of a 24-year-old schoolteacher in Kuwait who suffered acute liver injury after escalating doses of tirzepatide. The patient, a non-diabetic with a BMI of 34 kg/m², started weekly injections of tirzepatide in February 2024, gradually increasing the dose to 12 mg by June.
Symptoms and Progression
The patient initially presented with recurrent vomiting, nausea, and abdominal pain—symptoms that suggested hypoglycemia and mild metabolic disturbances. Despite initial discharge following stabilization, her symptoms recurred, and she developed acute hepatitis with impaired coagulation function. Further investigations revealed abnormal liver enzymes and mild fatty liver on a CT scan, though tests for viral hepatitis and autoimmune conditions were negative.
Severe symptoms, including abdominal pain and hypotension, required ICU admission. She was treated with vitamin K, fresh frozen plasma, and ursodeoxycholic acid under the care of gastroenterology and liver transplant specialists. Over ten days, her condition improved, and she was discharged with a significantly reduced BMI of 25 kg/m².
Potential Mechanisms
Researchers highlighted two potential mechanisms behind the liver injury:
- Prolonged Presence in Bloodstream: With a half-life of approximately five days, tirzepatide’s extended duration in the bloodstream could contribute to hepatotoxicity.
- Rapid Defatting of the Liver: High doses may induce rapid fat loss in the liver, causing direct cytotoxic injury.
A RUCAM score of 5 and the temporal correlation between tirzepatide use and the onset of symptoms strongly point to the drug as the likely cause.
Key Takeaways for Medical Practitioners
This case emphasizes the importance of vigilant monitoring during tirzepatide treatment:
- Regular Monitoring: Conduct routine liver function tests, renal tests, and INR to detect early signs of complications.
- Early Intervention: Severe gastrointestinal symptoms or persistent abdominal pain warrant immediate hospital admission for comprehensive evaluation, including CT imaging.
- Cautious Dosing: Gradual dose escalation must be approached carefully, with close attention to patient responses.
This report underscores that while tirzepatide remains a promising treatment for weight loss, its potential risks, including hepatotoxicity, demand cautious use and proactive management.