- Chad. A woman weighing 60 kg suddenly develops severe watery diarrhoea in the morning. In the evening she is brought to you. What signs of dehydration do you look for? What do you do?
- During a cholera epidemic in Peru you are brought a child who for 2 days has had very excessive watery diarrhoea. It has just had a convulsion. What do you think and what do you do?
- Colombia. You are brought a 19-year-old man. He has had diarrhoea for 3 days. He has fever of 39°
, looks toxic, and has to go to the toilet every half hour. The faeces are slimy. What do you think and what do you do?
- Bangladesh. A woman aged 20 years, 50 kg, has cholera. There was some dextrose 5% infusion in stock and an attempt had been made to rehydrate the patient. After 8 hours her fluid balance is clearly better, but as she is vomiting, her fluids policy needs to be continued. After 48 hours, however, she is having difficulty moving her arms and legs. Tendon reflexes are absent. Her heart beat is irregular. The intestinal peristalsis can no longer be heard. What do you think?
- Ecuador. A very weak, undernourished child aged 6 is admitted with rice water diarrhoea and vomiting. It is treated promptly with Ringer’s lactate IV. The following day it develops fever to 39.7°
and its respiration is fast and difficult. It is suspected that the acidosis has been insufficiently corrected so that the amount of bicarbonate is increased. Two days later the child dies. What should have been done?
- During a cholera epidemic vaccinations should be begun immediately and as a priority. hat do you think of this statement?
- Cholera is an example of isotonic contraction of the blood volume. Quasi-isotonic fluid is lost (diarrhoea with the same electrolyte composition as plasma). There is thus little exit of water from the intracellular compartment, although the haematocrit increases. In your answer compare and contrast the hypertonic contraction which occurs during thirst (e.g. stuporous patient who takes no drinks, excessive sweating without drinking water, osmotic diuresis) and the hypotonic contraction which occurs during kidney failure (more sodium than water is lost), intense participation in sports during hot weather, with only water to slake thirst, or those confined to bed who receive excessive glucose infusions.
