Colchicine has a narrow therapeutic window and a high risk of toxicity when co-administered with CYP3A4 inhibitors and P-glycoprotein inhibitors. Colchicine toxicity is associated with various metabolic disturbances and can cause multiorgan failure and death. However, to our knowledge, there are no documented reports of colchicine toxicity initially presenting as euglycemic diabetic ketoacidosis (DKA). We present a case of colchicine toxicity with concomitant euglycemic DKA in a man with long-term colchicine use who was also prescribed clarithromycin and dapagliflozin.