On a busy emergency shift, you have a series of patients with atypical presentations. Your first patient, Patient A, is a 38-year-old female with a distant history of anorexia nervosa, presenting with persistent, diffuse, abdominal pain, nausea, intractable vomiting, inability to tolerate oral intake, and fatigue for four days. She experienced a syncopal episode at work today. Her vital signs are within normal limits. Her lab work reveals a new metabolic alkalosis with hyponatremia, hypokalemia, hypochloremia, a lactate of 10.1 mmol/L, and an acute kidney injury with a creatinine of 1.78 mg/dL (from 0.72 mg/dL at baseline).

Patient B, a 62-year-old male with a history of obesity and diabetes, walks in for daily headaches without sudden onset but associated with nausea, generalized weakness, and lightheadedness, worsening over one month. His heart rate and blood pressure are elevated from his baseline. Given the fact that he has not had these headaches before and has diffuse symptoms including weakness, lab work and head imaging are obtained. There were no acute findings on head CT. His lab values demonstrate no anemia, leukocytosis, or electrolyte abnormalities except for an elevated creatinine.

Patient C, a 27-year-old female with a history of epilepsy, taking valproate and endorsing adherence, is then brought in by ambulance for a witnessed seizure. This is her first seizure in six years. She is postictal at the time of your assessment, but when she becomes more alert, your review of systems is pertinent only for her stating she has noticed oily stains on her underwear. She is highly concerned that when she passes stool, she has loose bowel movements, and her stools are surrounded by mucus.

Of note, you learn that all three of these patients recently started medications to lose weight.

The proliferation of medications available to the public for weight loss has resulted in increased prevalence of their use.¹ Many of these medications contain pharmacologic agents that have been used for other indications. Regulatory and pharmaceutical availability barriers have even resulted in changing of such medications while in treatment, incomplete usage, and alternative patterns of administration.² As such, the increased popularity of such medications ushers in a new era of challenges and presentations, particularly for the emergency physician.

Each of the aforementioned patients represents chief complaints secondary to the use of antiobesity medications. In each case, a detailed history of what medications were used, dosage, and frequency of use is imperative.