Dengue is the most common and important mosquito-borne viral infection and can manifest as Dengue Fever (DF), which is often a self-limiting febrile illness or less commonly dengue hemorrhagic fever (DHF). The major pathophysiologic hallmarks that distinguish DHF from DF and other diseases are increased vascular permeability leading to plasma leakage and circulatory collapse (Dengue Shock Syndrome/DSS). Management involves close monitoring and early detection of shock, with prompt and judicious use of appropriate fluids to correct hypovolemia, yet prevent fluid overload. Blood transfusions may be indicated in patients with refractory shock or shock in the presence of falling hematocrit.