Background and Objectives: The most gruesome complication of DKA is cerebral edema (CE) as it is not only associated with a high mortality rate but also leads to significant morbidity among the survivors. Therefore, it is prudent that clinicians emphasise on its early recognition so as to intervene quickly and timely. The present study was undertaken to study the association between cerebral edema and demographic features, initial laboratory characteristics and treatment related factors in children presenting with DKA at a tertiary care institute.Methods:This hospital-based cohort study was conducted in Paediatrics department of our hospital over three years from October 2019 to September 20222 including children >1 year to <15 years of age presenting to I.P.D or Emergency with DKA. Classification of DKA was done as per ISPAD 2018 guideline and cerebral edema was diagnosed on pre-set clinical criteria. Children with incomplete information regarding their treatment immediately prior to admission at our institute were excluded.Result: 118 children with DKA were enrolled over the 3 years out of which 69 were males and 49 were females with male: female ratio of 1.4:1. Mean age was 8.08 ± 3.26 years and mean weight was 19.47 ± 4.34 kg. Overall, 23 (194%) children were diagnosed to be suffering from CE. Children with CE had significantly worse pH, base deficit, bicarbonate level and serum osmolality at admissison. They also had a significantly higher incidence of prior i.v fluid bolus therapy, prior insulin therapy as well as prior bicarbonate therapy than those without CE. Such children also required a significantly longer duration of insulin infusion (37.3 ± 15.2 hours vs 18.4 ± 8.6 hours, p<0.0001) as well as a significantly longer duration of ICU stay (4.8±2.5 days vs 2.3 ± 1.1 days, p<0.0001).Conclusion:Occurrence of CE is related to the severity of underlying initial metabolic disturbances as reflected by a worse pH, base deficit, bicarbonate level and serum osmolality OR to a combination of factors associated with treatment of DKA including prior fluid bolus or insulin or bicarbonate therapy as well as overzealous rehydration of such children.