Aim and background: Euglycemic diabetic ketoacidosis (DKA) is ketoacidosis in individuals with near-normal blood sugar levels, making it difficult to diagnose. This can result in overlooked cases. Case description: A 46-year-old male with diabetes and hypertension presented with abdominal pain and fever. Gallstones and bile duct dilation were found. Elevated glucose levels and sugar in urine were detected. Gangrenous changes in the gallbladder were discovered during surgery. Severe metabolic acidosis required a ventilator and intensive care unit (ICU) transfer. Euglycemic DKA was considered due to sodium/glucose cotransporter-2 inhibitor (SGLT-2i) use. Treatment included fluids, insulin, and dextrose infusion. Extubation was successful the next day. Conclusion: Euglycemic DKA should be considered in critically ill patients with diabetes, even with low blood sugar or no ketones in the urine. Diagnosis involves assessing metabolic acidosis, measuring serum ketones, and ruling out other causes. Clinical significance: Euglycemic DKA is a metabolic emergency that poses a serious risk to life. Anesthesiologists, emergency medicine and intensive care units struggle with the absence of hyperglycemia because it might delay diagnosis and treatment, which harms patient outcomes, and its incidence has risen with the use of SGLT-2i.