Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes mellitus in children. Central nervous system changes seen in DKA include the altered sensorium seen commonly in DKA and loosely characterized as diabetic coma and the uncommon but worrisome progressively deepening coma caused by cerebral edema, which has both a high morbidity and mortality. This article discusses the assessment and treatment of DKA in the setting of the pediatric ICU.