| Objective To analyze the clinical characteristics of diabetic ketoacidosis (DKA) in children and summarize the experience of clinical treatment. Methods The clinical data of 43 children with first-episode diabetic ketoacidosis, who were hospitalized in Dalian Children's Hospital from January 2015 to August 2018, were retrospectively analyzed: age＜2 years old：2 cases（4.7%），≥2-5 years old: 7 cases (16%)，≥5-10 years old: 19 cases (44%)，≥10 years old: 15 cases (35%). Fifteen patients (35%) had a family history of diabetes, including type 2 diabetes mellitus within 2 patients. The patients’ clinical manifestations, signs, laboratory examinations, and treatment effects were observed. All hospitalized children were tested for blood, urine routine, blood sugar, blood gas analysis, blood sodium, blood potassium, renal function (urea nitrogen, creatinine), plasma effective osmotic pressure etc. Treatment was carried out according to the guidelines for diagnosis and treatment of diabetic ketoacidosis in children in 2009. Results The clinical symptoms include dehydration such as dry skin and decreased skin elasticity in 39 cases (91%); typical polydipsia, polyuria, polyphagia and emaciation in 34 cases (79%)；deep and sigh-like breathing in 26 (60%)；gastrointestinal symptoms such as vomiting and abdominal pain in 19 cases (44%)； chest tightness and shortness of breath in 25 cases (58%)； weakness of both lower limbs in 1 case. The patients were complicated with change of consciousness in 8 cases (19%); fever in 10 cases (23%); hyperglycemic hyperosmolar state in 3 cases；and cerebral edema in 1 case. Urinary sugar and ketone body were strongly positive in all 43 cases. Blood gas analysis revealed metabolic acidosis. All patients were given fluid resuscitation and continuous intravenous drip of ordinary insulin. Among them, 42 children with DKA were discharged from hospital, and 1 patient died due to poor prognosis of cerebral edema. Conclusion Clinical manifestations of DKA in children are complex, diverse and non-specific, easy to miss diagnosis and misdiagnose. Improved knowledge, early diagnosis and reasonable treatment are important to reduce the mortality rate of DKA.