Background:-Diabetic ketoacidosis is potentially fatal metabolic disorder commonly present in emergency department.It is a life threating complication of diabetes.If it misdiagnosed or mistreated it is 100% fatal. Purpose:- To study precipitating factors and clinical-laboratory features of diabetic ketoacidosis (DKA) atatTikurAnbesa Specialized Hospital Emergency department, Addis Ababa Ethiopia. DESIGN:- A prospective study by reviewing medical charts. SUBJECTS: A sampled 103 Adult patients aged 12 years and above with known or previously unknown diabetes presentingin the emergency department from January 2011 to January 2013 with a diagnosis of diabetic ketoacidosis. .. RESULTS: Mean (SD) age was 30.9 (12.11) years for males and 28.4 (14.4) for females. Majorityof patients 77(74.8%) were type I and 23(22.3%) were newly diagnosed. Infection was the leading precipitating factors 36(45%)and 24(30%) was due to treatment non adherence. Infection sites includegenito-urinary system, respiratory system and acute febrile illness. Only 11.1% had altered level of consciousness, when 8% were in coma and 35.9% had dehydration. More than half (52.7%) patients hadleukocytosis and 31.4% were hypokalemic. CONCLUSION and RECOMMENDATION Diabetic ketoacidosis commonly seen in TikurAnbesa hospital emergency department. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes of diabetic patients to not to complicate to DKAby improving patient education and access to care. Key words: Diabetic ketoacidosis, precipitating factors, clinical and laboratory feature, TikurAnbesa