Diabetic ketoacidosis (DKA) is a rare cause of the “pseudo-infarct pattern." It indicates the presence of EKG changes suggestive of myocardial ischemia without a coronary artery lesion. Pseudo-myocardial infarction has been associated with hyperkalemia seen in DKA. We report a case of ST elevation in the absence of a coronary artery lesion in a patient presenting with severe DKA and normokalemia. 41-year-old male with a history of type-1 diabetes mellitus with HbA1c of 13.6%, presented with altered mental status and unresponsiveness. He was intubated in the emergency department. Labs revealed severe DKA with glucose of 1307 mg/dl, non-calculable anion gap metabolic acidosis with bicarbonate level of <10 mEq/L, and B- hydroxybutyrate of 12.38mmol/L. Serum potassium level was normal at 5.1 mEq/L. Other electrolyte derangements include phosphorous at 11.9 mg/dl, magnesium at 4.6 mg/dl, and sodium at 146 mEq/L. Initial EKG revealed bradycardia without ischemic changes. He was started on DKA protocol with insulin drip, resulting in the closure of the anion gap and improvement of blood sugars. The next day, EKG was notable for ST elevations suggestive of anteroseptal infarction. Troponin level was 16.7 ng/ml. Serum potassium remained normal at 3.5 mEq/L. Due to risk factors for coronary artery disease (CAD), he underwent a coronary angiogram and was found to have normal coronaries. EKG changes are thought to be in the setting of DKA, which was subsequently resolved. Several cases have reported ST segment changes in patients with DKA. However, these have been associated with hyperkalemia. The EKG changes in our case were seen in the normokalemia setting and after the anion gap closure. In the absence of metabolic derangements, the etiology of the pseudo-infarct pattern remains unclear. As diabetes is a risk factor for CAD, these patients require ischemic evaluation with a coronary angiogram.