EuDKA caused by SGLT2 inhibitors is thought to be rare but real entity. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a relatively new class of oral antidiabetics for type 2 DM with renal and cardio protective benefits and acceptable safety profile. Although they are considered to be safe but US FDA issued a warning on use of SGLT-2 inhibitors about the risk of ketoacidosis. It is advised to health care professionals to consider the risk of EuDKA in patients who developed nausea, vomiting, abdominal pain, tiredness and difficulty in breathing while using it these drugs. We report a case of 52-year-old male recently diagnosed with type 2 diabetes developed EuDKA after 7 days of starting Empagliflozin therapy. The unique features in our case were presentation with severe pain abdomen and signs of peritonitis along with upper GI bleed. Very few cases have been reported in literature with such presentation. There was no precipitant factor like fever, sepsis, post-operative setting, fasting and decreased carbohydrate intake described in literature in our case. Use of SGLT2 inhibitors in catabolic state might be the precipitant factor in our case.
