Sodium glucose co-transporter (SGLT-2) inhibitor is a relatively new medication 
used to treat diabetes. At present, the Food and Drug Administration (FDA) has 
only approved three medications (canagliflozin, dapagliflozin and empagliflozin) 
in this drug class for the management of Type 2 diabetes. In May 2015, the FDA 
issued a warning of ketoacidosis with use of this drug class. Risk factors for 
the development of ketoacidosis among patients who take SGLT-2 inhibitors 
include decrease carbohydrate intake/starvation, acute illness and decrease in 
insulin dose. When identified, immediate cessation of the medication and 
administration of glucose must be done, and in some instances, starting an 
insulin drip might be necessary. We present a case of a patient with diabetes 
mellitus being on empagliflozin (SGLT-2 antagonist) who was admitted for acute 
cholecystitis. The hospital course was complicated by euglycemic diabetic 
ketoacidosis after being kept nothing per orem before a contemplated 
cholecystectomy.