Endocrine Abstracts

Introduction

Gastrointestinal adverse effects such as nausea and vomiting are widely described for GLP-1 receptor agonists (arGLP-1). We highlight Semaglutide, a drug that needs to start its administration at a reduced dose, to be able to increase the dose later with better tolerance and adherence of the patient. Not doing it this way can lead the patient to have serious adverse effects such as incoercible vomiting or profuse diarrhea that entails serious ionic alterations.

Case report

A 70-year-old man, living independently, diagnosed with type 2 diabetes mellitus and grade 2 obesity, treated with Empagliflozin 10 mg and Semaglutide 1 mg. He presented symptoms of general malaise, frequent vomiting, hyporexia and weight loss of 25 kg in the last 6 months (coinciding with the initiation of Semaglutide at an initial dose of 1 mg subcutaneous weekly). He suffers from worsening with incoercible vomiting and instability, so he goes to the emergency room, where he suffers a tonic–clonic crisis and cardiorespiratory arrest. Advanced cardiopulmonary resuscitation maneuvers were started and the patient proceeded to oropharyngeal intubation, recovering a pulse after 3 min, and he was transferred to the ICU. In the blood test extracted, severe hypocalcemia ( < 5 mg/dl) and hypomagnesemia (1.2 mg/dl) stand out, the rest without relevant alterations, with these values ​​in range in previous tests. In the study of hypocalcemia and hypomagnesemia, parathyroid hormone (PTH) 404 pg/ml, 1, 25-(OH)2 Vit D 32 pg/ml is observed, with a calcium excretion fraction < 0.01 and a magnesium excretion fraction 0.7%. After correction of calcium and magnesium levels, a new determination of PTH 57.5 pg/ml is performed, where normalization is observed. During the diagnostic process, occult neoplasia, thyroid disease, severe deficiency or resistance to vitamin D and resistance to PTH were ruled out. Given the patient’s history and the initiation of treatment with Semaglutide at 1 mg weekly, a dose higher than that indicated in the technical data sheet (0.25 mg weekly), we consider that serious gastrointestinal effects occurred in the patient, the deficiency etiology of hypocalcemia and hypomagnesemia being the most probable cause.

Conclusion

arGLP-1, and specifically Semaglutide, are excellent drugs for the control of patients with DM2, but they require that we know in depth the possible adverse effects and the appropriate form of administration of each of them.