A 42-year-old woman presents to your urgent care clinic with persistent nausea and intermittent vomiting for 3 days. She reports decreased appetite and mild upper abdominal discomfort but denies fever, diarrhea, hematemesis, or severe abdominal pain. Her medical history is significant for hypertension. She reports taking lisinopril. She has been unable to tolerate solid food but is drinking small amounts of water. Her vital signs are stable. On examination, she appears mildly uncomfortable. Her mucous membranes are slightly dry. Abdominal examination reveals mild epigastric tenderness without rebound or guarding.
Because the patient has persistent symptoms and signs of mild dehydration, laboratory tests are obtained. Comprehensive metabolic panel, lipase, and urinalysis are normal, which make pancreatitis unlikely. Further questioning reveals the patient began semaglutide injections 2 months ago for weight loss purchased through an online weight-loss program. Her BMI is 25. Her dose was increased 3 days ago. She states that her symptoms began shortly after the dose increase.
Which of the following is the most appropriate next step in management for this patient?
- Immediately transfer to the emergency department for abdominal computed tomography imaging
- Discontinue semaglutide and begin antibiotics
- Initiate metoclopramide to accelerate gastric emptying
- Temporarily reduce or hold the semaglutide dose and provide symptomatic treatment
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Correct answer: d. Temporarily reduce or hold the semaglutide dose and provide symptomatic treatment
Some patients obtain weight-loss medications from online brokers, compounding pharmacies, or other sources and may not initially disclose their use. GLP-1 receptor agonists commonly cause gastrointestinal symptoms, particularly during the first month of therapy or after dose escalation. You recognized that the timing of the patient’s symptoms and the dose increase aligned with adverse effects of semaglutide. Management for this patient included symptomatic treatment with antiemetics, hydration, dietary modifications, and dose reduction or temporary cessation of the medication until she could follow-up with the prescribing clinician. Prior to discharge, you counseled the patient about what side effects to expect from weight-loss medications and the dangers of obtaining and taking these medications without medical supervision.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
