Page 102 - Journal of Special Operations Medicine - Summer 2014

Figure 1 A cup of typical "rice-water" stool from a cholera
patient shows flecks of mucus that have settled to the bottom. BOX 1 How to Prepare Homemade
These stools are inoffensive, with a faint fishy odor. Oral Rehydration Solution (ORS)

n If ORS sachets are available: dilute 1 sachet in
1L of safe water
Otherwise

n Add to 1L of safe water:
– Salt: ½ small spoon (2.5g)
– Sugar: 6 small spoons (30g)

And try to compensate for loss of potassium (e.g.,
eat bananas or drink green coconut water).
Source: http://whqlibdoc.who.int/hq/2010/WHO_CDS
_CSR_NCS_2003.7_Rev.2_eng.pdf?ua=1.
Source: CDC Public Health Image Library.

Diagnosis BOX 2 When There Is No Sign of Dehydration
Because cholera often occurs in outbreaks, it should
be suspected in endemic areas. Stool cultures can only When there is NO sign of dehydration, give ORS
be performed where the specific thiosulfate-citrate-bile after each stool:
salts–sucrose agar is available. Several immunochro-
matographic dipstick tests are available and may be ob- n Child aged <2 yr: 50–100mL (¼–½cup) ORS
tainable in endemic areas. More than 200 serogroups of to ~½L/day
cholera have been identified, with the vast majority of n Child 2–9 yr: 100–200mL up to ~1L/day
disease caused by the O1 serogroup, which includes the n Patient aged ≥10 yr, as much as wanted up to
distinct biotypes El tor and classical. The El tor biotype ~2L/day
is the cause of the current global pandemic of cholera. And try to compensate for loss of potassium (e.g.,
The O139 serogroup has caused disease mainly in Asia. eat bananas or drink green coconut water).
Source: Adapted from http://whqlibdoc.who.int/hq/2010
Treatment and Vaccination /WHO_CDS_CSR_NCS_2003.7_Rev.2_eng.pdf?ua=1.
Complications from the acute diarrhea of cholera gravis
can kill within hours if the patient is not treated or is and are indicated for those with moderate to severe de-
treated improperly. Most patients, even those with se- hydration. A single 300mg dose of doxycycline has been
vere disease, can be treated with a combination of oral shown to be effective in adults; azithromycin at adult
rehydration salts and appropriate antibiotics. The World dosing for pregnant patients or at 20mg/kg (without
Health Organization Global Task Force on Cholera has exceeding 1g) in a single dose is the treatment for chil-
created guidelines for the rehydration of those affected dren. Zinc supplementation at 10mg/day for 10 days for
by cholera (Boxes 1–4, Figure 2). children younger than 6 months and 20mg/day for 10
days for children between 6 months and 5 years of age
Antibiotics can rapidly eradicate the organisms with a has been shown to reduce the duration and severity of
resultant decreased duration of diarrhea and fluid losses diarrhea in children with cholera infections.

BOX 3 When There Is Some Sign of Dehydration

Approximate amount of ORS solution to give in the first 4 hours:
AGE
<4 mo 4–11 mo 12–23 mo 2–4 yr 5–14 yr ≥15 yr
Weight, kg <5 5–7.9 8–10.9 11–15.9 16–29.9 ≥30
ORS, mL 200–400 400–600 600–800 800–1200 1200–2200 2200–4000
Source: Adapted from http://whqlibdoc.who.int/hq/2010/WHO_CDS_CSR_NCS_2003.7_Rev.2_eng.pdf?ua=1.

92 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014