Pneumomediastinum and epidural pneumatosis are rare complications of diabetic ketoacidosis (DKA). These result from the emesis and hyperventilation associated with DKA which lead to alveolar rupture and air escape into the mediastinal and epidural spaces. These complications are often asymptomatic and resolve with the correction of the underlying metabolic abnormality. Oesophageal contrast studies are only required if oesophageal perforation is suspected in patients presenting with persistent vomiting and chest pain. We report the rare association of pneumomediastinum and epidural pneumatosis complicating DKA in a 19-year-old female patient.