Type I diabetes mellitus is the most common endocrine– metabolic disorder of childhood and adolescence and  diabetic ketoacidosis (DKA) can be life threatening. The study aims at identifying precipitating factors, states epidemiological features and describes clinical presentations in children with DKA admitted to Pediatric Intensive Care Unit (PICU), Rajendra Institute of medical sciences,Ranchi. The hospital records of 80 children admitted to PICU with DKA between May  2016 and January 2017 were reviewed. Age at admission ranged between 8 months and 14 years (mean = 10.7 years). Female to male ratio was 1.22:1. A family history of diabetes (either type 1 or 2) was reported in 59 (74%). The leading precipitating factor for DKA was infections (82.1%). An episode of DKA was the first clinical presentation of diabetes among 52(65%). The common presenting symptoms were: vomiting in 57(71.3%) and abdominal pain in 53 (66.3%). All children were dehydrated. Other signs included acidotic breathing and tachypnea each in 60%. Only two children were comatose (2.5%). Three of presenting cases were initially misdiagnosed as acute appendicitis before correct diagnosis was established. Cerebral edema occurred in one child. There were no deaths. DKA is an important cause of hospital admissions in our hospital, and 65% of newly diagnosed cases present with DKA. More effort should be put to prevent and reduce the incidence of DKA at initial presentation and later.