Clinical Presentation & Management in Haiti

Oral Rehydration

Patients who vomit should be given small, frequent sips of ORS solution, or ORS solution by nasogastric tube. ORS solution should be made with safe water.

Approximate amount of ORS solution to give in the first 4 hours to patients with some dehydration. Use the patient’s age only when you do not know the weight.

• The approximate amount of ORS (in milliliters) can also be calculated by multiplying the patient’s weight in kg by 75.
• A rough estimate of oral rehydration rate for older children and adults is 100 ml ORS every five minutes, until the patient stabilizes.
• If the patient requests more than the prescribed ORS solution, give more.
• For infants: Encourage the mother to continue breastfeeding.

Notes

• The volumes and time shown are guidelines based on usual needs. If necessary, amount and frequency can be increased, or the ORS solution can be given at the same rate for a longer period to achieve adequate rehydration. Similarly, the amount of fluid can be decreased if hydration is achieved earlier than expected.
• During the initial stages of therapy, while still dehydrated, adults can consume as much as 1000 ml of ORS solution per hour, if necessary, and children as much as 20 ml/kg body weight per hour.
• Reassess the patient after 1 hour of therapy and then every 1 to 2 hours until rehydration is complete.
• Resume feeding with a normal diet when vomiting has stopped.

Intravenous Rehydration

Patients with severe dehydration, stupor, coma, uncontrollable vomiting, or extreme fatigue that prevents drinking should be rehydrated intravenously.

Intravenous solutions

• Best — Ringer's Lactate Solution
• Acceptable* — Normal Saline
• Unacceptable — Plain glucose (dextrose) solution

Start intravenous fluids (IV) immediately. If the patient can drink, give ORS solution by mouth while the IV drip is set up. Give 100 ml/kg Ringer’s Lactate Solution divided as follows:

*Repeat once if radial pulse is still very weak or not detectable.

• Reassess the patient every 1-2 hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200ml/kg or more may be needed during the first 24 hours of treatment.
• Also give ORS solution (about 5 ml/kg per hour) as soon as the patient can drink.
• After 6 hours (infants) or 3 hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.

An antibiotic given orally will reduce the volume and duration of diarrhea. Treatment with antibiotics is recommended for moderately and severely ill patients, particularly for those patients who continue to pass large volume of stools during rehydration treatment, and including all patients who are hospitalized. Do not give antibiotics to asymptomatic persons. Zinc given orally can reduce the duration of most infectious diarrhea in children. No drugs should be given for treatment of diarrhea or vomiting besides antibiotics and zinc.

Appropriate oral antibiotics (to be given by mouth)

These recommendations are based on the antibiotic resistance profile of V. cholerae isolates from the Haiti cholera outbreak, as reported on December 14, 2010, and local drug availability.

The V. cholerae isolates from people with cholera in Haiti have undergone antimicrobial susceptibility testing.

Current antibiotic testing results show*:

*Susceptibility testing of selected isolates from ill patients in Haiti will continue, and clinicians should be alert for changes in antibiotic treatment recommendations based on clinical experience in Haiti.

**Susceptibility inferred based on tetracycline testing.

Multiple first choice and second choice options are presented. Selection of antibiotics should be based on individual case consideration and available medications.

*Doxycycline is safe for treatment of cholera in children at the recommended dose. The Pan American Health Organization recommends doxycycline as a second-line choice because of limited regional availability and to avoid future overuse in children.

Zinc supplementation significantly reduces the severity and duration of most childhood diarrhea caused by infection. When available, supplementation (10-20 mg zinc per day) should be started immediately.

Clinical Presentation & Management

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Clinical Presentation & Management

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Clinical Presentation & Management

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