Mimics of sepsis are a common cause of misdiagnosis in the emergency department. Studies have shown that more than 50% of patients identified and treated for severe sepsis have negative culture results. Of the patients identified with a sepsis syndrome at presentation, 18% have a noninfectious disease that mimics sepsis. Hence, it is important to differentiate sepsis from several noninfectious diseases that may closely mimic sepsis. Conditions such as diabetic ketoacidosis (DKA), Kawasaki disease (KD) shock syndrome, pancreatitis, and inborn errors of metabolism (IEM) mimic the clinical presentation of sepsis, while anaphylaxis, adrenal insufficiency, hemorrhage, pulmonary embolism, and spinal cord injury mimic the hemodynamic parameters of sepsis. Due to a significant overlap in the clinical, hemodynamic, as well as laboratory parameters, sepsis and its mimics are often not distinguishable on the initial assessment. Unresolving sepsis with appropriate fluid resuscitation and antimicrobials may be a clue that it is not sepsis alone. High index of suspicion combined with a systematic approach and prompt therapy is important as many can be progressive and fatal. Nonetheless, sepsis is still the commonest. Beware mimics are there but rare!!