Abstract: Dehydration from fluid loss secondary to glycosuria is the central pathogenesis of diabetic ketoacidosis (DKA). Decreased oral intake and increased insensible water loss are also common in DKA. Severe dehydration should lead to hypovolemia and hypotension. We present a case of DKA with severe dehydration and hypertension in contrast to expected hypotension. The aim of this article was to increase awareness that pediatric DKA could present with hypertension, and this should be looked at and included in DKA management protocols.