When Should a Patient on GLP-1 Receptor Agonist Therapy Go to the Emergency Department?
A patient on GLP-1 therapy should immediately go to the ED for severe or persistent gastrointestinal symptoms (intractable vomiting/diarrhea lasting >24 hours), signs of dehydration or acute kidney injury (decreased urination, confusion, severe weakness), severe abdominal pain suggestive of pancreatitis or biliary disease, hypoglycemia symptoms if taking concurrent sulfonylureas or insulin, allergic reactions including injection site reactions progressing to systemic symptoms, or any cardiac symptoms (chest pain, shortness of breath) that persist beyond 5 minutes. 1, 2
Gastrointestinal Emergencies (Most Common)
The most frequent GLP-1-related complications requiring ED evaluation are gastrointestinal in nature:
Severe, persistent nausea and vomiting that prevents oral intake or medication administration for more than 24 hours requires immediate ED evaluation, as this is the most common adverse effect and can lead to dehydration and acute kidney injury 1, 2
Intractable diarrhea causing signs of volume depletion (dizziness when standing, decreased urination, dry mucous membranes) necessitates urgent assessment 1, 2
Severe abdominal pain, particularly epigastric pain radiating to the back, requires immediate ED evaluation to rule out pancreatitis, which has been associated with GLP-1 agonist use 1, 2
Right upper quadrant abdominal pain with nausea warrants urgent evaluation for biliary disease, as GLP-1 agonists may increase risk of gallbladder complications 1
Renal Complications
Any signs of acute kidney injury (markedly decreased urine output, confusion, severe weakness, swelling) require immediate ED transport, as renal adverse events are most commonly associated with severe GI fluid losses from GLP-1 therapy 1, 2
Hypoglycemia (Medication-Specific Risk)
Symptomatic hypoglycemia (confusion, sweating, tremor, palpitations, loss of consciousness) requires immediate ED evaluation if the patient is taking GLP-1 agonists concurrently with sulfonylureas or insulin, as this combination significantly increases hypoglycemia risk 1, 2
Patients on GLP-1 agonists with metformin or thiazolidinediones alone do not typically experience hypoglycemia requiring ED visits 2
Allergic and Injection Site Reactions
Progressive injection site reactions with spreading erythema, warmth, or systemic symptoms (fever, malaise) warrant ED evaluation 1
Any signs of anaphylaxis (difficulty breathing, throat swelling, widespread rash, hypotension) require immediate 9-1-1 activation and ED transport 1
Cardiac Symptoms
If chest discomfort or pain is unimproved or worsening 5 minutes after onset, the patient should call 9-1-1 immediately regardless of GLP-1 use, as this represents potential acute coronary syndrome requiring urgent evaluation 3, 4
Patients experiencing chest discomfort at rest for greater than 20 minutes, hemodynamic instability, or recent syncope should be referred immediately to an ED 3
Symptoms including radiation to arm(s), back, neck, jaw; shortness of breath; weakness; diaphoresis; nausea; or lightheadedness require immediate medical attention 3, 4
Critical Pitfalls to Avoid
Do not dismiss gastrointestinal symptoms as "expected side effects" if they are severe, persistent beyond 48 hours, or causing dehydration, as these can progress to acute kidney injury requiring hospitalization 1, 2
Do not delay evaluation for severe abdominal pain assuming it is GI upset, as pancreatitis and biliary disease require urgent diagnosis and management 1, 2
Patients obtaining GLP-1 medications from non-licensed or unregulated sources face increased risk of serious complications and should seek immediate ED evaluation for any concerning symptoms 1
Diabetic patients on GLP-1 therapy with new visual changes should be evaluated urgently, as there is increased risk of diabetic retinopathy progression 1