Abstract: ob＜x＞jectives To investigate the clinical risk factors of hyperlactatemia in children with diabetic ketoacidosis. Methods: A retrospective analysis was made of 101 children with diabetic ketoacidosis, aged 2-15 years, who were admitted to Huai’an First Hospital affiliated to Nanjing Medical University from January 2015 to December 2020. Moderate and severe; according to the serum lactate level, we divided the children into high lactate group (≥2.0mmol/l) and non-high lactate group (<2.0mmol/l). General indicators such as gender, age, new-onset diabetes, systolic blood pressure, diastolic blood pressure, etc. were collected, and the admission blood glucose, blood urea nitrogen, creatinine, glycosylated hemoglobin, PH, HCO3, serum sodium, serum potassium, lactate, total cholesterol, triglyceride, thyroid function and other clinical biochemical indicators were detected. The differences in clinical biochemical indexes were compared between the two groups; correlation analysis was conducted to explore the correlation between serum lactate level and clinical biochemical indexes, severity of DKA disease, correction time of diabetic ketoacidosis, and average hospitalization costs. Regression analysis of risk factors for hyperlactatemia in children with DKA. Results: Among the 101 DKA children, 42 had elevated serum lactate levels, with an average serum lactate level of 3.12 mmol/l. Compared with the non-high lactate group, the high lactate group had higher age and admission blood glucose, and lower PH and HCO3 levels. The incidence of onset diabetes in the high lactate group was lower than that in the non-high lactate group. Serum lactate level in DKA patients was positively correlated with DKA disease severity, age, admission blood glucose, and newly diagnosed diabetes, and negatively correlated with PH and HCO3. Serum lactate was not correlated with DKA correction time and hospitalization costs. Logistic regression analysis showed that admission hyperglycemia and new-onset diabetes were independent risk factors for elevated serum lactate levels in DKA patients. Conclusion: Elevated serum lactate level in children with diabetic ketoacidosis is closely related to admission hyperglycemia and new-onset diabetes. Hyperlactatemia in children with DKA had no significant effect on DKA correction time and hospital costs during hospitalization.