Semaglutide Linked to Severe Bowel Obstruction and Kidney Failure in Rare Case

Semaglutide, a widely prescribed glucagon-like peptide-1 (GLP-1) receptor agonist, is highly effective for managing type 2 diabetes and obesity, improving glycemic control and promoting weight loss. While its benefits are substantial, common side effects typically involve mild gastrointestinal disturbances such as nausea, vomiting, and constipation, which are usually transient. However, severe complications like small bowel obstruction (SBO) and subsequent acute kidney injury (AKI), particularly those requiring dialysis, are exceedingly rare and not well-documented in the literature. This unique case report addresses a critical knowledge gap by detailing an instance where semaglutide use was associated with the development of a severe small bowel obstruction, which then precipitated acute kidney injury requiring emergent renal replacement therapy, highlighting a potentially life-threatening, albeit uncommon, adverse event. This underscores the importance of continuous pharmacovigilance and a comprehensive understanding of all potential risks associated with increasingly popular medications.

The patient presented with classic symptoms indicative of small bowel obstruction (SBO), including severe, colicky abdominal pain, persistent nausea, and intractable vomiting, leading to significant dehydration. Initial laboratory tests revealed a rapid decline in renal function, with serum creatinine levels escalating from a baseline of approximately 0.8 mg/dL to over 4.0 mg/dL within a short period, indicating severe acute kidney injury (AKI). Imaging studies, specifically abdominal CT scans, confirmed the diagnosis of SBO, showing dilated bowel loops and air-fluid levels, without evidence of mechanical obstruction from other causes like adhesions or tumors. > The patient's acute kidney injury rapidly progressed to a stage requiring emergent hemodialysis, a critical and life-sustaining intervention that underscores the severity of renal impairment directly precipitated by the SBO and potentially exacerbated by the physiological effects of semaglutide. Despite intensive medical management, including intravenous fluid resuscitation and bowel rest, the patient's condition remained critical for several days, necessitating continuous monitoring in an intensive care unit. Renal function only began to show gradual improvement after the resolution of the small bowel obstruction and the complete cessation of semaglutide therapy, with the patient eventually being weaned off dialysis. This case starkly illustrates the potential for semaglutide to be associated with severe, life-threatening gastrointestinal and renal complications, even if such occurrences are exceedingly rare.