Coexistent dengue haemorrhagic fever and diabetic ketoacidosis: A therapeutic challenge

A 56-year-old Sri Lankan man presented with diabetic ketoacidosis (DKA) and he was in the critical phase of dengue haemorrhagic fever at the time of presentation. The concurrent presence of ketoacidosis and the leaking phase of dengue fever presents a challenge to a practising physician. He was successfully managed with careful fluid resuscitation taking into consideration the leaking phase of dengue fever and fluid depletion from diabetic ketoacidosis. The presence of diabetes increases the severity and the disease mortality in dengue fever. The metabolic disease-induced chronic inflammation and altered vascular endothelial integrity are thought to be the reasons for the increased mortality. Hyperglycemia results in polyuria which can mask oliguria and the depleted intravascular volume and shock status in dengue fever. Dengue fever can rarely precipitate diabetic ketoacidosis in diabetic patients. Using modified goal-directed fluid therapy according to the pathophysiology can avoid fluid overload and prolonged shock in complex situations.