Background: Combined use of Glucagon-like peptide-1 receptor agonists (GLP-1RA) & sodium-glucose cotransporter 2 inhibitors (SGLT2i) may provide particular advantages for treating type 2 diabetes mellitus (DM2). Both promote weight loss and have favorable effects on cardiovascular outcomes while minimizing hypoglycemic events, however, in some circumstances their combination might result in previously unexpected side effects. We describe a case where initiation of a GLP1RA appeared to induce euglycemic diabetic ketoacidosis (euDKA) in a patient taking an SGLT2i. Clinical Case: A 52-year-old woman with hyperlipidemia and DM2 presented with 3 days of nausea & vomiting. Approximately 1 week prior she started liraglutide due to suboptimal glycemic control on dapagliflozin (HbA1c 8%). She reported no fevers, chills, cough, dysuria, diarrhea or sick contacts. She had headache without meningeal signs. Laboratory findings were significant for leukocytosis (15.400/µL), low bicarbonate (12 mmol/L), hyperglycemia (206 mg/dL), low lactate (0.9 mmol/L) and glucosuria/ketonuria (+4). Venous blood gas revealed metabolic acidosis with pH 7.18, pCO2 37, HCO3 13.4. Based on these findings, the patient was diagnosed with euDKA due to dapagliflozin in the setting of liraglutide associated nausea. Insulin drip and IV fluids were initiated with rapid resolution of the metabolic disturbance. No infectious process was identified. Prior to starting dapagliflozin 10 months ago, she was on metformin, long acting and pre-meal insulin. She had ketoacidosis 8 months prior when liraglutide was first prescribed, but at the time it was attributed to infection in the setting of dapagliflozin, liraglutide and metformin use, and metformin and liraglutide were stopped, but dapagliflozin was continued. Conclusion: EuDKA is defined as diabetic ketoacidosis without marked hyperglycemia, generally