Case :- A 6 years old boy presented with fever since 4 days, pain in abdomen and puffiness of eyes since 2 days and vomiting since 1 day. There is no oliguria, rash, joint pains, jaundice or bleeding. On examination, pulse was 62/min, respiratory rate was 32/min and blood pressure was 88/66 mm of Hg. Periorbital puffiness was present. Perfusion was normal. On systemic examination, there was non-tender hepatomegaly and bilateral pleural effusion. Other systems were normal. Investigations showed hemoglobin of 11.6 gm%, WBC count of 6,400/cumm (45% polymorphs, 55% lymphocytes) and platelet count of 21,000/cumm. Peripheral smear for malarial parasites was negative. Liver transaminases were elevated (SGOT = 873 IU/L, SGPT = 1470 IU/L). He had hypoalbuminemia (Albumin = 2.1 gm/dl). Renal function tests, serum electrolytes and blood gases were normal. Both prothrombin time (PT) and partial thromboplastin time (PTT) were prolonged more than 1 minute. Leptospira tridot was negative and Dengue IgM was positive (1.1 AI). Ultrasound abdomen and Chest showed hepatomegaly with minimal ascitis and bilateral moderate pleural effusion. He was diagnosed as a case of Dengue shock syndrome and treated with normal saline boluses and IV fluids (4 cc/kg/hour) which was gradually increased to 10 cc/kg/hour in view of increasing PCV and oliguria and hypotension. He required plasma and platelet transfusion in view of malena. After 24 hours, child’s blood pressure was maintained and fluids were decreased to 4 cc/kg/hour. Subsequently, child suddenly became tachypneic (respiratory rate of 60/min) and had tachycardia with bilateral basal crepitations suggestive of pulmonary edema. Echocardiography showed good left ventricular functions with mild left ventricular hypertrophy, however, ECG showed ectopics. He was started on ionotropic support, furosemide infusion fluid restriction and artificial ventilation. Central venous pressure at that time was 30 cm of water. Patient responded to the same and stabilized within 24 hours. His parameters normalized within 3 days of presentation.