Treatment of Cholera in Adults (18+) When Oral Rehydration Has Not Resolved Dehydration
This protocol addresses adults 18 years and older with cholera who are not pregnant, and who have not achieved adequate control of dehydration through oral rehydration — requiring a more intensive management approach.
Clinical scenario
Patient is 18 years or older, with cholera, and is not pregnant. Oral rehydration has been attempted but has not been sufficient to resolve the clinical picture.
Why escalation is indicated
Initial management with oral rehydration solution (ORS) — given regularly to compensate for diarrhoeal losses — did not achieve the required clinical goals: absence of dehydration signs, ability to tolerate ORS without vomiting, cessation of watery stools, and restoration of urine output. This failure of the initial oral approach indicates the need for a different level of intervention.
Treatment approach (overview only)
This protocol uses intravenous fluid rehydration as its primary intervention, transitioning to oral rehydration as soon as the patient can tolerate it. An antibiotic component is also included in the approach. The complete agent selection and management sequence are available in the full structured regimen.
Clinical targets
- Resolution of dehydration
- Restoration of urine output
- Cessation of watery stools
References
- Refer to the flow chart for cholera case management for adults (Figure 3) and children (Figure 4).
- Patients with severe dehydration and shock require IV rehydration.
- The fluid of choice for rehydration is Ringer lactate (RL).
- If RL is not available, 0.9% sodium chloride (Normal Saline), with or without glucose, can be used.
- As soon as the patient can drink, replace ongoing losses with ORS.
- Antibiotics can reduce the volume and duration of diarrhea.
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