Background and aims: The mainstay of treatment of Severe Dengue (SD) according to the OMS is rapid ressucitation with isotonic cristaloid fluids, followed by plasma or colloids for severe or permanent shock. Aims: Our management consists in the use of hypertonic fluids, diuretics, vasoactive drugs use and non-invasive mechanical ventilation. Methods: We conducted an observational, descriptive and prospective study of 97 cases of SD of January to July 2013, in the PICU, Clinic of Rafael Uribe Uribe in Cali, Colombia.we used an alternate intervention protocol. It consists in the use of hypertonic fluids, diuretics, vasoactive drugs use and non-invasive mechanical ventilation in patients with pleural effussion. the family have signed written informed consent. Results: 50% of children belonged to the group of 6–11 years. Male gender (56%). Only 2 deaths occurred. The mean stay 3.9 days. The diagnostic tests were positive in 5% for IgM, 89% for IgG and 39% for NS1. The hematocrit and hemoglobin had a mean value of 2,87. The 58 percent of patients received non-invasive mechanical ventilation. The leucocyte count was between 1900 and 58,890 cells/mL. Minimal platelet count reached 8000/mm, with a mean of 41500/mm. The 78 percent of patients presented sodium and potassium between normal range. The 76% of patients had chloride values between 101 and 110. The Strong Ion Difference (SID) was normal in 79%, and low in 17% of patients. Hyperchloremic metabolic acidosis was not present. Conclusions: The study reports management with 3% hypertonic saline is inocuous, cheap and available, with a lesser rate of complications, morbidity and mortality.