Semaglutide linked to rare cascade of DKA, acute pancreatitis, and ruptured acalculous cholecystitis in 70-year-old
Background
Type 2 Diabetes Mellitus (T2DM) management often involves GLP-1 receptor agonists like semaglutide, known for their efficacy in glycemic control and weight loss. While generally well-tolerated, these agents can cause gastrointestinal side effects, and rarely, acute pancreatitis or cholecystitis. This case highlights a complex and severe sequence of events, including diabetic ketoacidosis (DKA), acute pancreatitis, and a subsequent gallbladder rupture, raising questions about the interplay between GLP-1R agonism and severe physiological stress in predisposing to complex biliary complications.
Study Design
This case report describes a 70-year-old male with type 2 diabetes who presented with severe abdominal pain and dyspnea after 24 weeks of treatment with weekly subcutaneous semaglutide (1 mg). He was initially diagnosed with acute pancreatitis and diabetic ketoacidosis (DKA). After 5 days of stabilization, he was transferred from the intensive care unit to a general ward. However, new systemic symptoms prompted further investigation, including a repeat abdominal computed tomography scan, which revealed the subsequent complication.
Results
The 70-year-old patient, after 24 weeks on semaglutide (1 mg), presented with acute pancreatitis and DKA. Following 5 days of stabilization and symptom relief, he was transferred to a general ward. However, he subsequently developed a high-grade fever persisting for 3 days, accompanied by severe leukocytosis, despite normalized serum lipase levels. A repeat abdominal computed tomography scan revealed acute acalculous cholecystitis complicated by gallbladder rupture. The patient underwent emergency percutaneous transhepatic gallbladder drainage and antibiotic therapy, leading to gradual recovery. This rare cascade suggests potential predisposing factors related to GLP-1 receptor agonists.
The patient developed a high-grade fever persisting for 3 days, accompanied by severe leukocytosis, despite normalized serum lipase levels, leading to the diagnosis of acute acalculous cholecystitis complicated by gallbladder rupture.
Key Findings
- A 70-year-old patient on semaglutide (1 mg) developed concurrent acute pancreatitis and DKA.
- After initial stabilization, the patient developed a high-grade fever for 3 days and severe leukocytosis.
- Repeat imaging revealed acute acalculous cholecystitis complicated by gallbladder rupture.
- The patient required emergency percutaneous transhepatic gallbladder drainage and antibiotics for recovery.
Why It Matters
This case underscores the importance of heightened clinical vigilance in patients receiving GLP-1 receptor agonists, particularly when new or recurring systemic symptoms emerge after initial stabilization from a critical illness. Clinicians should maintain a high index of suspicion for repeating imaging studies in such scenarios. The report prompts further investigation into whether pharmacological effects of GLP-1 receptor agonists, such as biliary stasis, might act as a predisposing factor for complex biliary complications in the setting of severe physiological stress. This could influence future monitoring protocols or risk stratification for individuals on these medications.
semaglutide
diabetic-ketoacidosis
acute-pancreatitis
cholecystitis
case-report
type-2-diabetes