SGLT2 inhibitors are a new class of drugs for lowering blood sugar levels in type 2 diabetics. They have been shown to reduce cardiovascular risk along with improving glycemic control. Some of the SGLT2 inhibitors are Canagliozin, Dapagliozin, Empagliozin, Ertugliozin, Remogliozin. We are presenting a case of a 60-yearold female patient who is a known case of Type 2 Diabetes Mellitus presented to the emergency room with loss of responsiveness for 1 day gradual in onset. Her history revealed she is type 2 diabetic for the past 10yrs and was hospitalized 20days back when her RBS was 889mg/dl & urine ketones were positive with a diagnosis of type 2 DM with DKA. since then, she was put on Tab Dapagliozin 10mg OD along with other OHA's. On presentation, the patient was unconscious GCS-E1, V2, M2-5/15, pulse3 100/min, BP-80mm of hg systolic, glucometer RBS-211 mg/dl, ABG showed severe metabolic acidosis pH-6.86, HCO -2.9mmol/L, 2 PCO -24mm hg, PaO2-58mm hg, urine ketones came positive, and the patient was managed conservatively. The patient responded well, and her GCS improved with stabilization in her condition. Dapagliozin and other SGLT2 inhibitors can cause Euglycemic DKA, and these can be missed out in the emergency room as they have not so high blood sugar levels making the diagnosis of DKA difcult in emergency conditions.

Scrub typhus is a rickettsial disease predominantly seen in Asian pacic region. It is caused by pathogen Orientia tsutsugamushi. Vector involved in scrub typhus is larval trombiculid mite(chigger). It presents as acute febrile illness with cough, severe headache and myalgia. Complications include pneumonitis, acute respiratory distress syndrome, myocarditis, meningitis etc. Eschar or rash may not be present. Severity of illness can range from mild symptoms to multi-organ failure and death. We report a case of scrub typhus who presented with fever, shortness of breath and low oxygen saturation in emergency. Patient is a middle aged female with no known co-morbidities. Initially she was kept in COVID-19 suspected ICU and was managed supportively. HRCT was suggestive of Acute Respiratory Distress Syndrome (ARDS). RT-PCR for SAR-CoV2 came out negative. On evaluation it was found that she was having scrub typhus. In present scenario, not all patients who are having symptoms of fever, shortness of breath can be COVID19, scrub typhus is one of those illnesses which may present similar to COVID19. Early diagnosis and prompt treatment of scrub typhus is essential as any delay might lead to dreadful complication and can be fatal.