Introduction: Diabetic ketoacidosis is a life threatening acute complication of diabetes mellitus characterized by a biochemical triad of hyperglycemia blood glucose >11 mmol/L, Venous pH <7.3 or bicarbonate <15 mmol/L, Ketonemia, and ketonuria, which it needs immediate attention with fluid and insulin infusion. Identifying determinants of diabetic ketoacidosis is essential to improve quality of life of the child and care givers; decrease diabetic ketoacidosis management associated costs, and prevents further debilitating complication of diabetic ketoacidosis. Objective: The aim of this study was to determine factors associated with diabetic ketoacidosis among type one diabetic children admitted in Amhara region public comprehensive specialized hospitals, Northern Ethiopia, 2022. Methods and materials: Institutional based unmatched case-control study design was conducted among 400 (80 cases and 320 controls) type one diabetes children in Amhara region public comprehensive specialized hospitals from May 06 to July10, 2022. Sample was proportionally allocated, and taken through systematic random sampling technique. After identified case and controls, data was collected by using structured interviewer-administer questionnaire and a review of case records. Both bi-variable and multi-variable logistic regressions were applied. Determinants that had p-value ≤ 0.25 on bi-variable regression analysis were entered to final model. The data were presented in the form of texts and tables. Results: In the present study, diabetic children who have no health insurance (AOR=3.84, 95% CI 1.81, 8.13), malnourished children (AOR=5.2, 95% CI: 2.61-10.36), previous diabetic ketoacidosis history (AOR=2.83, 95%CI: 1.03-7.81), poor dietary adherence (AOR=6.67, 95% CI: 3.02-14.73), missed diabetic follow up (AOR=1.24, 95%CI: 1.24- 5.50), and low drug adherence (AOR=2.58, 95% CI: 1.02-6.59) were determinant factors of diabetic ketoacidosis. Conclusion and recommendation: Based on the findings of this study uninsured, undernutrition, previous ketoacidosis, poor diet adherence, missed follow up and low drug adherence were identified determinants factors of diabetic ketoacidosis. Strengthen community based health insurance and malnutrition screening program, provide comprehensive diabetic care is essential to prevent diabetic ketoacidosis. Keyword: Diabetic ketoacidosis, type one diabetes mellitus, Amhara region, Ethiopia