Diabetic ketoacidosis is a life-threatening complication of diabetes, which typically arises due to insulin deficiency and increased counterregulatory hormones. Although it is usually seen in patients with established diabetes, clinicians should have a high index of suspicion, as it may be the initial presentation in children with type 1 diabetes mellitus. Patients can present with vague, variable symptoms and usually exhibit signs of hypovolemia. Laboratory findings include hyperglycemia, the presence of a high anion gap metabolic acidosis, and ketonemia/ketonuria. Early recognition and intervention are paramount to prevent morbidity and mortality.