Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 335 340 EN Mahmoud Mohammed ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Eriks Sliders ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Ashraf Alakkad Internal Medicine Department, Madinat Zayed Hospital, SEHA, United Arab Emirates. Osama Ahmed SEHA Kidney Care, Abu Dhabi, United Arab Emirates. Mostafa Saleh CU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. & Critical Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October, Egypt. 2025 06 30 2025 07 07 Diabetic ketoacidosis (DKA) may become life-threatening when accompanied by acute pancreatitis, sepsis, and acute respiratory distress syndrome (ARDS), resulting in a cascade of inflammation and multi-organ dysfunction. We describe a 70-year-old male with severe DKA complicated by septic shock, ARDS, and multi-organ failure, who required individualized, precision-based fluid therapy. Aggressive but closely titrated resuscitation, guided by dynamic clinical markers, together with early initiation of Continuous Renal Replacement Therapy (CRRT), achieved stabilization. This case highlights the value of adaptive fluid management and timely CRRT in critically ill patients with complex DKA. https://aacc.tums.ac.ir/index.php/aacc/article/view/1329