GLP-1 receptor agonist toxicity
Background
- GLP-1 receptor agonists are injectable medication used for diabetes management and weight loss
- Poison control centers have reported increasing inquiries related to possible overdoses
GLP-1 Agonist Types
| Short Acting | Dose |
|---|---|
| Exenatide (Byetta) | 5-10 mcg SC bid |
| Liraglutide (Victoza, Saxenda) | 0.6-1.8 mg SC daily |
| Long Acting | |
| Exenatide (Bydureon) | 2 mg SC qwk |
| Albiglutide (Tanzeum) | 30-50 mg SC qwk |
| Dulaglutide (Trulicity) | 0.75-1.5 mg qwk |
- Lixisenatide (Lyxumia, Adlyxin)
- Semaglutide (Ozempic, Rybelsus, Wegovy)
- Tirzepatide^ (Mounjaro, Zepbound)
^Dual GLP-1 and GIP agonist
Clinical Features
Similar to side effects normally associated with these medications, but worse:
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
Workup
- CBC
- Chemistry
- LFTs + lipase
Diagnosis
- Typically a clinical diagnosis (based on history)
Management
- Symptomatic management
- Anti-nausa medications (e.g., zofran)
- Consider stopping other glucose-lowering (i.e, diabetic) medications
Disposition
- If symptoms can be controlled, patients can normally be discharged
- Consider discharge with zofran and hold of diabetic medications for ~1 week