Background: Diabetic ketoacidosis is potentially fatal metabolic disorder present mostly in accident and emergency departments. The mortality rate for diabetic ketoacidosis ranges from 2 to 5 percent in developed countries and 6 to 24 percent in developing countries. Objective: To assess the prevalence of diabetic ketoacidosis and associated precipitating factor among admitted diabetes patient at Tibebe Ghion Specialized Hospital from Feb. 2019 to September 2021 Gregorian calendar. Method: Institution based retrospective study; Based on card review of diabetes adult patients admitted to Tibebe Ghion Specialized Hospital medical ward was employed. The sample size was determined using computer-based Epi info7 software Stat Cal to be 148.In the specified study period from 210 diabetic patients, 148 diabetic patient charts were taken by using simple random sampling with lottery method. The quality of the data was assured through careful design and pretesting of the tools, proper training for data collector. Data was cleaned, coded and analyzed by using SPSS version 28. The analysis results were summarized using descriptive summary measure by using frequency tables and charts. Binary logistic regression was used to assess the association of dependent and independent variables. Both bi-variable and multi-variable analysis was conducted. Independent variables with a p-value of less than 0.25 in the bi-variable analysis were considered in the multivariable analysis. Odds ratio with 95 % confidence intervals and associated p-values was computed to assess the presence and degree of association between dependent and independent variables. Result: A total of 148 DM subjects were studied. The mean age in male is 40(+17.7) and female is (39.88 +15.77). The overall prevalence of DKA is high/76.4 %. Highest burden of DKA had seen in the range of 20-30years..In this study the most sounding precipitating factor in the study subjects was infection which accompanied 40.5 % cases. Conclusion: The overall prevalence of DKA in DM patients among admitted diabetic adult patients in TGSH medical ward from Feb. 2019 to Sep.2021GC is high/76.4 %. Highest burden of DKA have seen in the range of 20-30years. Infection (53.6 % cases) is the most precipitant identified. In this study type of DM ,duration of DM ,poly symptoms, blood sugar level ,urine ketone have significant association with prevalence of DKA with P-value of <.05 .