Cholera medical therapy: Difference between revisions

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* Number and quantity of stools and vomit in order to compensate for the loss of body fluids
* Number and quantity of stools and vomit in order to compensate for the loss of body fluids
* Radial pulse: if it remains weak, IV rehydration has to be continued.
* Radial pulse: if it remains weak, IV rehydration has to be continued.
===Method to Prepare home made ORS solution===
===Method to prepare home made ORS solution===
* If ORS sachets are available: dilute one sachet in one litre of safe water
* If ORS sachets are available: dilute one sachet in one litre of safe water
* Otherwise: Add to one litre of safe water:
* Otherwise: Add to one litre of safe water:

Revision as of 20:40, 4 April 2012

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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)

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 (table 2)

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






Maintenance of hydration & monitoring the patient

Reassess the patient for signs of dehydration regularly during the first six hours:

  • Number and quantity of stools and vomit in order to compensate for the loss of body fluids
  • Radial pulse: if it remains weak, IV rehydration has to be continued.

Method 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]

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