Background: Diabetic ketoacidosis (DKA) is a serious complication that ‘primarily affects individuals with type 1 diabetes but can also occur in patients with type 2 diabetes under certain conditions’. The objective was to compare the biochemical profiles and severity of DKA in adult patients with type 1 and type 2 diabetes and to evaluate the use of serum BHB in monitoring the resolution of DKA. Methodology: This descriptive-analytic study involved 121 adult patients diagnosed with DKA (60 diabetes type 1 and 61 diabetes type 2) admitted to tertiary care hospital, Peshawar. Demographic data, biochemical parameters, and severity of DKA were compared between the groups. Serum BHB levels were monitored during DKA treatment to assess its role in tracking resolution. Statistical analyses p-values less than 0.05 were considered significant.