Objective To explore the correlation between serum uric acid (SUA) and diabetic ketoacidosis (DKA) of children in initially diagnosed type 1 diabetes (T1DM). Methods The clinical data of children with T1DM admitted from March 2015 to June 2022 were retrospectively analyzed. The clinical characteristics of children between DKA group and non-DKA group were compared, and the correlation between SUA level and the occurrence of DKA in children with initially diagnosed T1DM was analyzed. Results A total of 358 children with T1DM (190 boys and 168 girls) were included, and the median age was 5.8 (3.0-8.9) years. There were 186 children (52.0%) in the DKA group and 172 in the non-DKA group. There were 57 children in the mild DKA group, 64 in the moderate DKA group and 65 in the severe DKA group. A total of 49 children with HUA were diagnosed, including 43 (23.1%) in the DKA group. The blood glucose, SUA level and the proportion of co-infection on admission in the DKA group were higher than those in the non-DKA group, and the C-peptide and glomerular filtration rate in the DKA group were lower than those in the non-DKA group, and the differences were statistically significant (all P<0.05). The receiver operating characteristic (ROC) curve showed that the area under the ROC curve of SUA predicting the DKA occurrence in children with initially diagnosed T1DM was 0.94 (95%CI: 0.91-0.97). When SUA≥294.2 μmol/L, the sensitivity and specificity predicting the DKA occurrence were 92.5% and 89.0%, respectively. Spearman rank correlation analysis showed that the SUA level was negatively correlated with the valueslevels of pH and HCO^-₃ in children with initially diagnosed T1DM (P<0.01). There were statistically significant differences in SUA levels between non-DKA group and DKA groups with different degrees (P<0.01). Pairwise comparison showed that SUA levels in mild, moderate and severe DKA groups were higher than those in non-DKA group, with statistical significance (P<0.05). Conclusions The determination of SUA level has certain clinical significance in assisting the assessment of whether the initial T1DM is combined with DKA, which is conducive to the disease assessment and can be carried out in grass-roots hospitals.