Examination of 394 cases of diabetic ketoacidosis presenting at the Children's Hospital of Oklahoma from 1975 to 1987 has indicated a higher frequency of very young patients with low insulin requirements and frequent presentation in the winter months. The severity of the preceding hyperglycemia varies widely as indicated by the range of glycosylated hemoglobin values at the time of diagnosis. In addition we have identified measures to prevent the main hazards occurring during therapy which are related to potassium replacement and correction of dehydration without causing cerebral edema. The general principles of management are reviewed and we have selected certain aspects for emphasis and discussion based on past experience.