24 year old starts weight loss journey with Tirzepatide, suffers acute liver Injury: Case report

Kuwait: A case study published in the European Journal of Case Reports in Internal Medicine highlights the importance of healthcare practitioners being aware of tirzepatide's potential hepatotoxicity ensuring timely management and intervention when necessary.

The case has detailed the nasty experience of a 24-year-old female schoolteacher who began a weight-loss regimen with tripeptide. She developed an idiosyncratic drug-induced liver injury after escalating doses of tirzepatide prescribed by a private practitioner. Initially presenting with recurrent vomiting, nausea, and abdominal pain—symptoms suggestive of hypoglycemia and mild metabolic disturbances—her condition progressed to acute hepatitis with impaired coagulation function.

Although Tirzepatide is a popular treatment for weight loss but there have been reports of hepatotoxicity linked to tirzepatide use, with the exact mechanism behind the liver injury still unknown. The recent case described by Irrum Abdullah, Internal Medicine Department, Adan Hospital Kuwait, Hadiya, Kuwait, and colleagues has raised concerns about potential liver toxicity, highlighting the need for caution and monitoring during its use.

As reported,  a non-diabetic female schoolteacher with a BMI of 34 kg/m² began using tirzepatide for weight loss in February 2024. She presented to the hospital in July 2024 with recurrent vomiting, nausea, and abdominal pain. Initial tests showed metabolic acidosis and hypokalemia but normal liver function. After treatment, she was discharged in stable condition but readmitted two days later with recurring symptoms and hypoglycemia. A CT scan revealed mild fatty liver but no acute issues. Her liver enzymes, however, were concerning, and she developed severe abdominal pain and hypotension, requiring ICU admission. Treatment included vitamin K, fresh frozen plasma, and ursodeoxycholic acid, with ongoing care from the gastroenterology and liver transplant teams.

Serological tests for viral hepatitis and autoimmune diseases were negative, and a liver biopsy was declined. Over the next ten days, her liver enzymes gradually improved, and she was discharged on July 19, 2024, with a BMI of 25 kg/m². The patient had been using tirzepatide from February to June 2024 and had recently discontinued oral contraceptives. There was no history of alcohol use, smoking, or autoimmune diseases.

The case highlighted the potential hepatotoxicity of tirzepatide and underscores the need for careful monitoring during treatment."In this case, the patient began weekly tirzepatide injections, starting with 2.5 mg and gradually increasing to 12 mg by June. After the final 12 mg dose, she experienced recurrent hospital admissions for abdominal pain and vomiting. Tirzepatide has a half-life of approximately five days, meaning it stays in the bloodstream for an extended period, potentially contributing to the observed liver injury. A RUCAM score of 5 and the temporal relationship between tirzepatide use and acute liver injury strongly suggest the drug as a likely cause," the researchers wrote

 "Another potential mechanism for liver injury could be rapid defatting of the liver due to the high dose of tirzepatide. This could have led to direct cytotoxic injury, further exacerbating the liver damage.," they noted 

The case report noted the following learnings, which are essential for medical practitioners.

• • Tirzepatide should be used cautiously, with regular monitoring of liver function tests.

  • If patients develop severe gastrointestinal symptoms or worsening abdominal pain, immediate hospital admission is necessary for further work-up, including a CT abdomen.

  • Daily liver function tests, renal function tests and international normalised ratio (INR) tests should be conducted to identify and manage potential complications.

Reference: Abdullah I, El-Ghousain H, Alenezi M. Tirzepatide-related acute liver injury. EJCRIM 2024;11:doi:10.12890/2024_004813