There remain a number of important controversies in the management of pediatric DKA. From the sodium content of the hydrational fluid to the rate of fluid administration that is best able to reverse the hyperosmolar dehydration attendant with DKA with minimal morbidity and mortality, there is no universal agreement on how patients with this devastating metabolic disturbance should be treated. It is still unclear what promotes or protects patients from neurologic insult during DKA reversal. It is appropriate to begin to develop a national approach to eradicating DKA. This would require widespread public and professional education programs aimed at detecting new-onset type I patients prior to the onset of DKA. It would involve promoting diabetes screening programs aimed at detecting patients before the onset of symptomatic disease, and these would most appropriately be centered in the pediatrician's office. In the known patient, DKA still occurs as the result of intercurrent illness and nonadherence to the diabetes regimen due to patient or family chaos and dysfunction. Clearly, more strategies are needed to address these psychological and family patterns and the fact that many tenuous families have insufficient access to appropriate medical care. Those caring for children and adolescents must do all they can to prevent DKA and to treat it optimally to avert the toll this metabolic aberration takes on the pediatric diabetes population.