Cholera is an intestinal infection with Vibrio cholerae, spread through water or food contaminated with stool. Its toxin makes the gut pour out huge volumes of watery stool, and a person can go into shock from dehydration within hours.
Key symptoms
- Sudden, painless, very large volumes of watery stool that looks like rice water
- Vomiting
- Intense thirst and little or no urine
- Muscle cramps, mostly in the legs
- Weakness, dizziness or fainting
What you find on exam
- Dry mouth, sunken eyes and skin that stays tented when pinched
- Fast, weak pulse and low blood pressure
- Cool hands and feet, slow capillary refill
- Restlessness, lethargy or confusion in severe cases
- Weigh the patient and estimate the percent of fluid lost
Tests
- Stool culture on selective media, or a rapid stool test for Vibrio cholerae
- Electrolytes: low potassium and low bicarbonate are common
- Kidney function and blood glucose, mostly in children
- Ask about travel, water source and contacts; report to public health
Treatment basics
- Oral rehydration solution for mild to moderate dehydration
- Severe dehydration or shock: IV lactated Ringer's by fast boluses
- Replace ongoing stool losses volume for volume
- Single-dose doxycycline in adults, or azithromycin in children and pregnancy
- Zinc for children; safe water, sanitation and handwashing
Red flags
- Weak or absent pulse, low blood pressure or cold, mottled skin
- No urine for many hours
- Drowsiness, confusion or not able to drink
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.