Background: Diabetic ketoacidosis (DKA) is a severe complication of diabetes mellitus. This study aims to evaluate the clinical features and biochemical profile in DKA patients, with a focus on serum bicarbonate levels and osmolality. Methods: This observational study was conducted at PESIMSR, Kuppam, with 88 patients presenting with DKA. Data on age, symptoms, biochemical parameters, and outcomes were collected and analyzed. Key variables include serum bicarbonate levels, serum osmolality, and their correlation with patient outcomes and hospital stay duration. Results: The study population had a mean age of 47.25 years. Type 2 diabetes accounted for 72.7% of cases. A majority (75%) of the patients had uncontrolled diabetes with HbA1C >9.6%. Serum bicarbonate levels below 10 mEq/L were significantly associated with longer hospital stays and poorer mental status. Mortality was 6.8%, and infection was the most common precipitating factor for DKA (40.9%). Conclusion: Serum bicarbonate levels and serum osmolality are crucial predictors of outcomes in DKA patients. Early intervention and management of biochemical abnormalities can improve patient outcomes.