Sweta Lohani, MD1, Iyad Al-Bustami, MD, MPH1, Aashutosh Sah, MD2, Chaula Desai, MD1, Saigopal R. Gujjula, MD1, Jamil Shah, MD3 1Brooklyn Hospital Center, Brooklyn, NY; 2MacNeal Hospital Loyola Medicine, Berwyn, IL; 3The Brooklyn Hospital Center, Brooklyn, NY Introduction: With the expanding clinical use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in managing diabetes, facilitating weight loss, and reducing cardiovascular risk, provider awareness of the medications' adverse effects remains incompletely characterized. While literature has numerous cases of major adverse events for GLP-1RA use, no delayed onset adverse events have been reported. Here, we present two cases demonstrating delayed-onset intolerance resulting in adverse events and hospitalization.
Case Description/
Methods: A 63-year-old female with a history of hypertension, CAD, HLD, T2DM presented with colicky abdominal pain radiating to the flank, associated with intractable nausea and vomiting. She reported medication adherence. On examination, she was afebrile but hypertensive (187/92 mmHg) with mild epigastric tenderness. Laboratory studies revealed hypokalemia (2.8 mEq/L), hyperglycemia (177 mg/dL). Medication list revealed she had been on a GLP-1 RA for glycemic control for months with no recent dosage increase. The timing of symptom onset correlated with her weekly injection. Repeat EGD showed no significant pathology. She required hospitalization for IV fluids, electrolyte correction, and symptom control. Her symptoms resolved with cessation of the medication.
A 49-year-old female with hypertension, carotid artery stenosis, history of CVA presented with acute onset of nausea, vomiting, diaphoresis, and central crushing chest pain shortly after restarting semaglutide 2 mg following a two-week hold for colonoscopy. She denied abdominal pain, dyspnea, palpitations, or fever. CTA chest ruled out pulmonary embolism or aortic dissection with mild esophageal thickening, suggesting esophagitis. Given the clear temporal relationship with semaglutide reinitiation, her presentation was attributed to delayed onset GLP-1 RAs adverse event. Discussion: These cases highlight the need to recognize delayed-onset adverse reactions of GLP-1 receptor agonists. Even patients who previously tolerated GLP-1 therapy well may develop severe gastrointestinal symptoms over time, possibly due to delayed gastric emptying or underlying gastroparesis. Careful monitoring is important, especially after restarting treatment following a medication holiday. As GLP-1 RAs continue to gain popularity, understanding their safety profile is essential for optimizing health care costs.
Disclosures: Sweta Lohani indicated no relevant financial relationships. Iyad Al-Bustami indicated no relevant financial relationships. Aashutosh Sah indicated no relevant financial relationships. Chaula Desai indicated no relevant financial relationships. Saigopal Gujjula indicated no relevant financial relationships. Jamil Shah indicated no relevant financial relationships.
Sweta Lohani, MD1, Iyad Al-Bustami, MD, MPH1, Aashutosh Sah, MD2, Chaula Desai, MD1, Saigopal R. Gujjula, MD1, Jamil Shah, MD3. P0577 - Delayed Onset Intolerance of GLP-1 Receptor Agonist Therapy: A Case Series of Adverse Reactions Requiring Hospitalization, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
