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The clinical manifestations are heterogeneous, but they can also differ depending on the grade and duration of the deficiency

severe or persistent upper abdominal pain should prompt urgent medical assessment [10] [11] Dehydration and acute kidney injury (AKI): gastrointestinal fluid losses can lead to dehydration, which may precipitate AKI, particularly in those with pre-existing renal impairment or those taking nephrotoxic medicines Delayed gastric emptying: this may affect the absorption of orally administered medicines, including contraceptive pills and thyroid replacement therapy [11] Injection site reactions: redness, bruising, or discomfort at the subcutaneous injection site Heart rate changes: increases in resting heart rate have been noted with GLP-1 class agents [14] [15] Hypoglycaemia: particularly if used alongside insulin or sulphonylureas Potential pancreatitis risk: a class concern with GLP-1 receptor agonists

Repairing and upgrading an existing cooling tower can deliver significant cost savings and extend the operational life of the system

Tirzepatide is approved at up to 15 mg weekly (Mounjaro/Zepbound)