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Clinical Cholera Case Management

Clinical Cholera Case Management. CME PRESENTATION 4/2/16 By Pastory Mondea. Cholera – case definitions. Diarrhea – 3 or more loose stools/24 hours Suspected Person > 5 years with severe dehydration or death from acute watery diarrhea with or without vomiting.

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Clinical Cholera Case Management

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  1. Clinical Cholera Case Management CME PRESENTATION 4/2/16 By PastoryMondea

  2. Cholera – case definitions • Diarrhea – 3 or more loose stools/24 hours • Suspected • Person > 5 years with severe dehydration or death from acute watery diarrhea with or without vomiting. • Person aged over 2 years with acute watery diarrhea in an area where there is a cholera outbreak. • Confirmed • Clinical illness PLUS laboratory confirmation of infection: • Isolation of V. cholera O1 or O139 from vomitus or stool

  3. Important Clinical Features and Laboratory Findings • Hypovalemic • Dehydration • Hypokalemia • Hyponatremiaor Hypernatremia • Hypocalcemia • Acidosis • Renal failure • Hypoglycemia • These need to be intervened

  4. Important to Note • Cholera kills • Cholera can be treated and death can be prevented in most cases! • 3 key interventions to reduce Case Fatality Rate (CFR) • Early case detection • Improve access to care • Appropriate case management • Cholera treatment starts at home

  5. Triaging -Decision Making Chart

  6. Cholera Treatment • Depends on severity of dehydration and cholera case confirmation 1. Oral Rehydration Solution (ORS) – home made or manufactured • 80% of patients recover with ORS • 10-20% need administration of IV fluids 2. IV fluids – RL, NS (dextrose unaccepted, no electrolyte replacement) 3. Zinc supplementation - Use daily x 10-14 days in children <5y 4. Use of antibiotics http://rehydrate.org/ors/low-osmolarity-ors.htm

  7. Minimal to No Dehydration – Plan A Treatment http://www.bing.com/images/search?q=oral+rehydration+solution&view=detailv2&&id=30D455D47FD3B3D47C4581EA0BF9BAC77C58E189&selectedIndex=4&ccid=4t3j1PQK&simid=608010002184736627&thid=JN.D14JX5iNQaUYWN4MjbhutQ&ajaxhist=0

  8. Moderate dehydration – Plan B Treatment • ORS administration in the first 4 hours (generally 75 x weight (kg)) • If unable to take oral, use NG tube • Vomiting often ceases within 2-3 hours after dehydration has improved. If pt. is thirsty, administer more ORS • Observe pt. to ensure required amount of ORS is administered • If after 4 hours, pt. has signs of dehydration, use Plan C • Monitor urine output

  9. Severe dehydration –Plan C Treatment - Intravenous fluids -Large bore 18 gauge IV needles -Can use nasogastric tube if IV cannot be placed (20ml/kg 1st hour) Source: CDC trainers of trainers presentation

  10. Putting IV Line

  11. Antibiotic Therapy • Recommended antibiotics – taken orally • Doxycyclin – Not for children - Adult: 300 mg by mouth in one dose 2. Cirprofloxacin – not for children - Adult: 500 mg bid 3/7 3. Erythromycin – For Pregnant patients and children: 500 mg 4 times a day for 3 days, 48mg/kg/24 hrs tds x3/7(for children). 4. Cotrimoxazole - 48mg/kg/24 hrs bid x 3/7(for children). • Source: National Guidelines for Prevention and Control of Cholera, Tanzania

  12. Cholera Therapy - What Not To Use • Anti-diarrheal agents • Anti-spasmodic agents • Anti-emetics • Steroids • Tea, sweetened or carbonated drinks in place of ORS • Plain dextrose • Prophylactic antibiotics

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