BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood glucose levels, leading to severe complications over time. Diabetic ketoacidosis (DKA) is a critical acute complication of DM marked by hyperglycemia and acidosis due to ketone body accumulation, often seen in younger patients. The pathophysiology involves insulin deficiency and the effects of counter-regulatory hormones, leading to increased gluconeogenesis and lipolysis. This study investigated the relationship between urine netrin-1 and β-hydroxybutyrate (β-OHB) levels in DKA patients. METHODS: The study included 40 patients diagnosed with DKA and 40 healthy controls. Urine samples were collected, centrifuged, and stored at -80℃. Netrin-1 and β-OHB levels were measured using BTlab quantitative ELISA kits. Data were analyzed using SPSS, with tests for normality and appropriate statistical comparisons conducted. RESULTS: No significant demographic differences were found between the patient and control groups. Urine ketone and glucose positivity were significantly higher in DKA patients. Blood glucose, urea, lactate, and metabolic acidosis markers were also elevated in DKA patients. No significant difference was found in urine β-OHB and netrin-1 concentrations between the groups. However, a moderate positive correlation between β-OHB and netrin-1 was observed, along with various significant correlations between these markers and other biochemical parameters. CONCLUSIONS: This study highlights significant biochemical differences between DKA patients and healthy controls, emphasizing the importance of monitoring biochemical parameters for managing DKA. Although no significant differences in urine β-OHB and netrin-1 concentrations were found, their correlation suggests a potential role in DKA pathophysiology, warranting further research with larger sample sizes.