Cholera medical therapy: Difference between revisions
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| No / Mild dehydration | | No / Mild dehydration | ||
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* Child < 2 years: 50–100 ml (1/4–1/2 cup)ORS solution. Up to approximately 1/2 | * Child < 2 years: 50–100 ml (1/4–1/2 cup)ORS solution. Up to approximately 1/2 liter a day. | ||
* Child between 2 and 9 years: 100–200 ml. Up to approximately 1 | * Child between 2 and 9 years: 100–200 ml. Up to approximately 1 liter a day. | ||
* Patient of 10 years of age or more as much as wanted, up to approximately 2 | * Patient of 10 years of age or more as much as wanted, up to approximately 2 liters a day. | ||
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| Irritable | | Irritable | ||
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* Give Oral Rehydration Salt in the amount recommended in below in table 2 | * Give Oral Rehydration Salt in the amount recommended in below in table 2 | ||
* Nasogastric tubes can be used for | * Nasogastric tubes can be used for re-hydration when ORS solution increases vomiting and nausea or when the patient cannot drink | ||
* Monitor the patient frequently | * Monitor the patient frequently | ||
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===Management of patients with some/moderate dehydration (table 2)=== | ===Management of patients with some/moderate dehydration (table 2)=== | ||
Revision as of 14:55, 5 April 2012
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Cholera Microchapters |
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Cholera medical therapy On the Web |
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Risk calculators and risk factors for Cholera medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [3]
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 |
|
| Irritable | Sunken | Drink eagerly | Goes back slowly (< 2 sec) | Some / Moderate dehydration (in case if 2 of the symptoms are present) |
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| 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) |
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)
Antibiotics
- Use antibiotics in severe cases only.
- Doxycycline single dose 300 mg or tetracycline 12,5 mg/kg 4 time/day for 3 days
- Young children: erythromycin 12,5 mg/kg 4 time/day for 3 days
- for children below 6 months of age: 10 mg daily for 10 days add zinc
- for children 6 months to 5 years of age: 20mg daily for 10 days add zinc
Nutrition
- Proper attention on nutrition is important as patients with cholera often ignore nutrition due to diarrhea and vomiting. This may lead to hypoglycemia and associated complications like seizure, coma and even death in pediatrics population.
- Provide frequent small meals with familiar foods during the first two days rather than infrequent large meals
- Breastfeeding of infants and young children should continue