Cholera physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]

Overview

Signs of cholera on physical examination depend on the patient's level of dehydration. Cholera patients may present with tachycardia, postural hypotension, somnolence, dry mucous membrane, sunken eyes, and/or oliguria. If severe diarrhea and vomiting are not aggressively treated, they can, within hours, result in life-threatening dehydration and electrolyte imbalances. The typical symptoms of dehydration include dizziness (due to low blood pressure), wrinkled hands (due to poor skin turgor), sunken eyes, muscle cramps (due to hypokalemia), and decreased urine output.

Physical Examination

The presentation of cholera upon physical examination depends on the patient's level of dehydration.

Vitals

• Weak or absent pulse; tachycardia
• Postural hypotension

Appearance of the Patient

• Somnolence and coma
• Dry mucous membrane

Skin

• Wrinkled skin

Eyes

• Sunken eyes

Assessment of Dehydration

Mental status	Eyes	Thirst	Skin pinch	Conclusions
Normal, alert	Normal, hydrated	Normal	Goes down quickly (spontaneously)	No / Mild dehydration
Irritable	Sunken	Drink eagerly	Goes back slowly (< 2 sec)	Some / Moderate dehydration (in case if 2 of the symptoms are present)
Severe	Sunken	Drinks poorly	Goes back slowly (> 2 sec)	Severe dehydration (in case if 2 of the symptoms are present)