Empagliflozin, a sodium–glucose co-transporter 2 (SGLT2) inhibitor, is widely prescribed for type 2 diabetes mellitus (T2DM) and heart failure. Despite its proven cardiovascular and renal benefits, rare but serious cases of diabetic ketoacidosis (DKA), including euglycemic DKA (euDKA), have been reported. This article reviews the incidence, mechanisms, risk factors, clinical features, and management strategies of empagliflozin-associated DKA. Early recognition and preventive strategies are essential to balance risks and benefits of therapy.

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