Diabetic ketoacidosis (DKA) is a common and generally well-understood medical condition in urgent and acute care centers. There are numerous conditions that have similar presentations to DKA but are better served with different treatment modalities. This article discusses the clinical presentation, diagnostic criteria, and management pearls of euglycemic DKA, alcoholic acidosis, fasting ketosis, and ketosis of pregnancy to help the reader more clearly distinguish between conditions to optimize patient care and outcomes.