“SGLT2 Inhibitor-Associated Diabetic Ketoacidosis in a Pediatric Patient: An Off- Label Use Case Report”

A 7-year-old boy presented with new-onset type one diabetes mellitus (T1DM) and moderate diabetic ketoacidosis (DKA). The patient presented with polyuria, polydipsia, and weight loss along with reduced activity and excessive sleepiness. Initial blood tests revealed elevated blood glucose levels, high anion-gap metabolic acidosis, and ketonuria. The patient was treated with fluid resuscitation, insulin infusion, and electrolyte replacement, which resolved within three days. During medication reconciliation, the patient was administered empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, by a family member without medical supervision. This case highlights the challenges in managing pediatric diabetes, potential risks of unauthorized medication use, and need for comprehensive family education in diabetes care. This also raises questions regarding the safety and benefits of SGLT2 inhibitors in children under 10 years of age with type 1 diabetes mellitus, an area that requires further research.