Cholera medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 59: Line 59:
|+ '''Assessment of dehydration'''
|+ '''Assessment of dehydration'''
|-
|-
   ! Mental status
   ! Age
   ! Eyes
   ! Less than 4 months
   ! Thirst
   ! 4–11 months
   ! Skin pinch
   ! 12–23 months
   ! Conclusions
   ! 2–4 years
   ! Management
   ! 5–14 years
  ! 15 years
|-
|-
   | Normal, Alert
   | Weight
   | Normal, hydrated
   | Less than 5 kgs
   | Normal
   | 5–7.9 kg
   | Goes down quickly (spontaneously)
   | 8–10.9 kg
   | No / Mild dehydration
   | 11–15.9 kg
   |
   | 16–29.9 kg
* Child < 2 years: 50–100 ml (1/4–1/2 cup)ORS solution. Up to approximately 1/2 litre a day.
   | 30 kg or more
* Child between 2 and 9 years: 100–200 ml. Up to approximately 1 litre a day.
* Patient of 10 years of age or more as much as wanted, up to approximately 2 litres a day.
|-
  | Irritable
  | Sunken
  | Drink eagerly
  | Goes back slowly (< 2 sec)
  | Some / Moderate dehydration (in case if 2 of the symptoms are present)
  |
* Give Oral Rehydration Salt in the amount recommended in below in table 2
* Nasogastric tubes can be used for rehydration when ORS solution increasesvomiting and nausea or when the patient cannot drink
* Monitor the patient frequently
|-
  | Lethargic, unconscious or floppy
  | Sunken, absence of tears
  | Drinks poorly
  | Goes back slowly (> 2 sec)
  | Severe dehydration (in case if 2 of the symptoms are present)
   |
* Put an IV drip to start intravenous rehydration
* In case this is not possible, rehydrate with ORS
* Give IV drips of Ringer Lactate or if not available cholera saline (or normal saline)
* 100 ml/kg in three-hour period (in 6 hours for children aged less than 1 year)
* Start rapidly (30ml/kg within 30 min) and then slow down.
Total amount per day: 200 ml/kg during the first 24 hours
|-
|-
  | ORS solution in ml
  | 200–400
  | 400–600
  | 600–800
  | 800–1200
  | 1200–2200
  | 2200–4000
|}
|}


====HOW TO PREPARE HOME-MADE ORS SOLUTION?====
====HOW TO PREPARE HOME-MADE ORS SOLUTION?====

Revision as of 19:59, 4 April 2012

Cholera Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cholera from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other diagnostic studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Cholera medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cholera medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cholera medical therapy

CDC on Cholera medical therapy

Cholera medical therapy in the news

Blogs on Cholera medical therapy

Directions to Hospitals Treating Cholera

Risk calculators and risk factors for Cholera medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Choleria is a severe bacterial gastrointestinal, diarrheal disease. In its most severe forms, cholera is one of the most rapidly fatal illnesses known. A healthy person may become hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. More commonly, the disease progresses from the first liquid stool to shock in 4-12 hours, with death following in 18 hours to several days without rehydration treatment.[1][2]

Medical therapy

Summary of the treatment

  • Rehydrate with ORS or IV solution depending on the severity. Rehydration involves replenishment of the lost fluids and then maintenance of the fluid balance
  • Maintain hydration and monitor frequently the hydration status
  • Give antibiotics for severe cholera cases

Management of cholera patients (table 1)

Assessment of dehydration
Mental status Eyes Thirst Skin pinch Conclusions Management
Normal, Alert Normal, hydrated Normal Goes down quickly (spontaneously) No / Mild dehydration
  • Child < 2 years: 50–100 ml (1/4–1/2 cup)ORS solution. Up to approximately 1/2 litre a day.
  • Child between 2 and 9 years: 100–200 ml. Up to approximately 1 litre a day.
  • Patient of 10 years of age or more as much as wanted, up to approximately 2 litres a day.
Irritable Sunken Drink eagerly Goes back slowly (< 2 sec) Some / Moderate dehydration (in case if 2 of the symptoms are present)
  • Give Oral Rehydration Salt in the amount recommended in below in table 2
  • Nasogastric tubes can be used for rehydration when ORS solution increasesvomiting and nausea or when the patient cannot drink
  • Monitor the patient frequently
Lethargic, unconscious or floppy Sunken, absence of tears Drinks poorly Goes back slowly (> 2 sec) Severe dehydration (in case if 2 of the symptoms are present)
  • Put an IV drip to start intravenous rehydration
  • In case this is not possible, rehydrate with ORS
  • Give IV drips of Ringer Lactate or if not available cholera saline (or normal saline)
  • 100 ml/kg in three-hour period (in 6 hours for children aged less than 1 year)
  • Start rapidly (30ml/kg within 30 min) and then slow down.

Total amount per day: 200 ml/kg during the first 24 hours

Management of patients with some/moderate dehydration

Assessment of dehydration
Age Less than 4 months 4–11 months 12–23 months 2–4 years 5–14 years 15 years
Weight Less than 5 kgs 5–7.9 kg 8–10.9 kg 11–15.9 kg 16–29.9 kg 30 kg or more
ORS solution in ml 200–400 400–600 600–800 800–1200 1200–2200 2200–4000

HOW TO PREPARE HOME-MADE ORS SOLUTION?

  • If ORS sachets are available: dilute one sachet in one litre of safe water
  • Otherwise: Add to one litre of safe water:
    • Salt 1/2 small spoon (2.5 grams)
    • Sugar 6 small spoons (30 grams)
  • Try to compensate for loss of potassium (for example, eat bananas or drink green coconut water)

References

  1. McLeod K (2000). "Our sense of Snow: John Snow in medical geography". Soc Sci Med. 50 (7–8): 923–35. PMID 10714917.
  2. WHO Cholera [1]

External links


Template:WikiDoc Sources