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Immediate medical attention is necessary if bloating is accompanied by: Severe, persistent, or worsening abdominal pain that does not resolve with position changes or over-the-counter remedies Inability to pass gas or have bowel movements, suggesting possible bowel obstruction Persistent vomiting, particularly if unable to tolerate oral fluids, raising concern for gastroparesis or pancreatitis Signs of dehydration (dizziness, reduced urination, dark urine) Fever, which may indicate infection or inflammation Bloody or black tarry stools Right upper quadrant pain or jaundice (yellowing of skin or eyes), which may suggest gallbladder disease Unintentional rapid weight loss beyond expected therapeutic effects Patients should stop tirzepatide and contact their healthcare provider immediately if they experience severe or persistent abdominal pain, with or without vomiting, as these may be symptoms of acute pancreatitis

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As secondary symptoms, many MdDS patients develop anxiety and depression 4,24