For Patient C’s steatorrhea, labs to assess metabolic function, and lipase helps. Her seizure is more concerning and warrants full assessment of possible infectious, toxic, and metabolic etiologies that may be contributing. Obtaining a serum level of the antiepileptic medication may assist in diagnostic certainty. Ultimately, stopping orlistat is the treatment.

Conclusion

Antiobesity medications present a new challenge to emergency medicine. This practice update underscores the importance of controlling symptoms, investigating potential electrolyte abnormalities, toxicity, hypoglycemia, and co-ingestion with other medications, and ensuring close outpatient follow-up. Asking patients about their use of such agents can help us better care for them when they present for acute, unscheduled care.

Dr. Sanky is an emergency medicine physician at the Mount Sinai Health System in New York.

Dr. Lin is an emergency medicine physician at Mount Sinai Health System in New York.

References

1. Suran M. As Ozempic’s popularity soars, here’s what to know about semaglutide and weight loss. JAMA. 2023;329(19):1627-1629.
2. Wright DR, Guo J, Hernandez I. A prescription for achieving equitable access to antiobesity medications. JAMA Health Forum. 2023;4(4):e230493.
3. Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA. 2023;330(18):1795-1797.
4. Ahmann AJ, Capehorn M, Charpentier G, et al. Efficacy and safety of once-weekly semaglutide versus exenatide ER in subjects with type 2 diabetes (SUSTAIN 3): a 56-week, open-label, randomized clinical trial. Diabetes Care. 2018;41:258–66.
5. Goodman B. Poison centers see nearly 1,500% increase in calls related to injected weight-loss drugs as people accidentally overdose. CNN website. Published December 18, 2023. Accessed January 11, 2024.
6. Contrave (naltrexone HCl/bupropion HCl) prescribing information. Deerfield, Illinois: Takeda Pharmaceuticals America Inc; 2014.
7. Mercer S. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. 2011;2(9):484-486.
8. Azer SA, Sankararaman S. Steatorrhea. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541055/. Published January 2023.Updated May 16, 2023.
9. Bansal AB, Al Khalili Y. Orlistat. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK542202/. Published January 2023. Updated December 11, 2022.
10. Bigham S, McGuigan C, MacDonald BK. Reduced absorption of lipophilic anti-epileptic medications when used concomitantly with the anti-obesity drug orlistat. Epilepsia. 2006;47(12):2207.