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Diabetic ketoacidosis is a rare but serious and life-threatening acute complication of diabetes mellitus. It is characterized by ketoacidosis with other findings and should be treated immediately. In this case, a 33-year-old diabetic patient who admitted to the emergency department with diabetic ketoacidosis is presented. The patient was prescribed empagliflozin (sodium glucose cotransporter inhibitor-2) a month ago. The SGLT-2 inhibitors have been approved for use in the treatment of type 2 DM and are still not used in the treatment of type 1 DM. There are such reports of unusual side effects related SGLT-2 inhibitors, in the literature and among them, ketoacidosis is a rare and important side effect.

Autoimmune hemolytic anemia is a disease characterized by destruction of red blood cells (RBC) and anemia, caused by production of antibodies released against the body’s own RBCs. While this condition is more commonly idiopathic, it may accompany autoimmune diseases as well. Cold agglutinin disease (CAD) is a rare subtype of acquired autoimmune hemoliytic anemia, however, is an idiosyncratic clinical and pathological terminology, usually seen in older ages. This condition is caused by IgM antibodies called “cold agglutinins” formed against I antigens on RBC membranes which cause agglutination of RBCs at lower temperatures. In this case, a 56 year old male patient who was diagnosed with CAD secondary to Epstein-Barr virus (EBV) infection is being presented.

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Creatine kinase levels are typically markedly elevated, and muscle pain and myoglobinuria may be present. Its causes are variable. Acute kidney injury is a common complication of rhabdomyolysis. Our patient is a 51-year-old male who was brought to the hospital with a complaint of generalized tonic-clonic seizures and weakness. His creatine phosphokinase levels increased on the first day of admission to 93,809 U/l. Creatinine level was found to be 9.13 mg/dl in the first biochemistry test. He was diagnosed to have an acute kidney injury and rhabdomyolysis. Hemodialysis was not performed to patient. Sixteen days after first admission, the patient’s rhabdomyolysis resolved.