Background: Diabetic ketoacidosis (DKA) is a very serious, acute pediatric type 1 diabetes (T1DM) complication. This study aimed to determine the risk factors and clinical aspects of DKA. Methods: Children hospitalized for DKA from January 2000 to December 2012 were included. Cases were classified as mild, moderate, or severe according to the clinical and laboratory results collected during that time period. Statistical significance was defined as P < 0.05. Results: Fifty-nine DKA cases (pH ≤ 7.3) were confirmed among 43 patients. The average age was 11.98 ± 4.40 years (range, 1.3–19.9 years). Thirty-one patients had previously experienced DKA. DKA was most frequent in moderate cases (21 cases, 35.6%), followed by severe (19 cases, 32.2%) and mild cases (19 cases, 32.2%). Clinical manifestation did not differ; however, severe cases exhibited more aggravated metabolism (e.g., hyperglycemia, elevated corrected serum Na and effective serum osmolality). Female patients were more frequently severe and moderate (P = 0.041). HbA1c levels did not differ between initial and recurrent cases. Two female patients (11.2 and 13.4 years) died with symptoms of brain edema. The mortality rate was 3.39% (2/59). Only the blood sugar level differed significantly between surviving and non-surviving cases (P = 0.022). Conclusion: In this study, no statistically significant differences were identified besides blood sugar levels. However, female patients should be carefully diagnosed and treated. Proper blood sugar level maintenance and continuous education are needed, particularly in summer, even among previously diagnosed and insulin-treated T1DM patients.