Diabetic ketoacidosis is the most common, life-threatening, acute complication of diabetes mellitus. Severe hyperlipidemia, causing lipemic serum, is rarely seen in case of diabetic ketoacidosis. Here, we will discuss a 10-years old girl who presented with ketoacidosis and had milky plasma appearance and severe hyperlipidemia. There was a milky appearance in blood sample drawn for biochemistry studies. In laboratory, blood sample could not be evaluated due to excessively lipemic sample; thus, repeated measurement was performed. In the second measurement, glucose, triglyceride, total cholesterol, LDL-cholesterol and HDL-cholesterol levels were found to be elevated. Diabetic ketoacidosis was considered as initial clinical diagnosis in our unconscious patient with acidotic respiration and acetone odor. With this case presentation we emphasized that serum lipid levels should be measured in diabetic ketoacidosis and diabetic children with poor glucose control. Additionally, we wanted to share management of hyperlipidemia in this case. It also should be kept in mind that blood measurements can be inaccurate in hyperlipidemic conditions; thus, stimulating the laboratory in the presence of hyperlipidemia may require a second measurement.