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If pancreatitis is suspected, tirzepatide should be discontinued immediately and not restarted if pancreatitis is confirmed Right upper quadrant pain, fever, or jaundice, which may suggest gallbladder disease (gallstones are more common during rapid weight loss) Vomiting blood or passing black, tarry stools, suggesting gastrointestinal bleeding Signs of dehydration including reduced urine output, dizziness, confusion, or rapid heartbeat Inability to tolerate any oral intake for more than 24 hours Severe abdominal distension or absence of bowel movements, which could indicate bowel obstruction Jaundice (yellowing of skin or eyes) or dark urine, potentially indicating hepatobiliary complications Patients should also seek medical review if gastrointestinal symptoms persist beyond the initial adaptation period (typically 48 weeks) or worsen despite dietary modifications and dose stabilisation

This episode is a must-listen for anyone looking to better understand MCAS and the challenges surrounding its diagnosis and care

It was protecting an incomplete regulatory process from accountability

Tohoku J

Acknowledgements D.J.D