A 16-year-old, previously healthy Thai girl presented with DHF grade III. Fifteen hours after the first episode of
shock, she had received an excessive amount of crystalloid isotonic solution and 20 ml per kilograms of Dextran-40 however
she still had persistently rapid pulse rate and high hematocrit but also had polyuria with more than 4 ml/kg/hr of urine output.
She was re-evaluated. Clinical signs showed severe dehydration with some ascites without signs of pleural effusion. Blood gas
revealed increased anion gap metabolic acidosis. The cause of polyuria and metabolic acidosis was identified with hyperglycemia,
ketouria and glucosuria. Afterwards she was diagnosed and treated as DHF grade III and DKA. Besides insulin administration,
fluid resuscitation was very crucial. Intravenous fluid rehydration was needed while the unnecessary extra-volume could
cause massive plasma leakage and later on fluid overload. Volume replacement was adjusted to degree of dehydration when
signs of volume overload were monitored closely. She was out of DKA at 14 hours after the start of insulin and the intravenous
fluid was stopped at 27 hours (36 hours after the first episode of shock). The final diagnosis was DHF grade III, diabetes
mellitus with DKA and hepatitis.

Keywords: Dengue Hemorrhagic Fever, Diabetic ketoacidosis