Ketoacidosis (DKA) is a frequent acute complication (50% of cases, inaugural of diabetes) and a cause of morbidity and mortality in children with diabetes. It can be revealing of diabetes or occurring in a known diabetic child. Patients and methods: Retrospective study of diabetic ketoacidosis cases managed according to the ISPAD 2018 protocol and collected in the pediatric department of the University Hospital of Bizerte over a period of 5 years (2018-2022). Results: Forty-four cases were collected, with an average page of 9 years, a female predominance was noted, DKA was inaugural in 30 cases. It was severe in 17 cases. The main circumstance of discovery was the polyuropolidipsic syndrome. Hydroelectrolytic disorders were dominated by hypokalemia in 8 cases. The management was done according to the protocol of L'ISPAD 2018 with an average duration of 24 h. The evolution was favorable in all cases, only one patient presented a hypoglycemia during the management.