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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

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5 Conclusion Overall, our study showed a neutral effect of GLP-1RA on the risk of major arrhythmias