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Diabetic ketoacidosis is an endocrine emergency. A subset of diabetic patients may present with relative euglycemia with acidosis, known as euglycemic diabetic ketoacidosis (EDKA), which is often misdiagnosed due to a serum glucose 250mg/dL. This narrative review evaluates the pathogenesis, diagnosis, and management of EDKA for emergency clinicians. EDKA is comprised of serum glucose 250mg/dL with an anion gap metabolic acidosis and ketosis. It most commonly occurs in patients with a history of low glucose states such as starvatio