DSS is distinguished from DHF by the presence of cardiovascular compromise, which occurs when plasma leakage into the interstitial spaces results in shock. DSS is a fatal condition with mortality rates as high as 20% but can also be less than 1% in places with sufficient resources and clinical experience. Common clinical warning signs for DSS include a rapidly rising haematocrit, intense abdominal pain, persistent vomiting, and narrowed or absent blood pressure (5).