Table 1.
Comparison of the composition of cholera stools and acceptable therapeutic fluids for cholera (67;134); (www.cotsprogram.com).
| Na+ | K+ | Cl- | HCO3- | Carbohydrate | Commentary | ||
|---|---|---|---|---|---|---|---|
| millimoles/liter | |||||||
| Electrolyte losses in stools* | Cholera stool, adult | 130 | 20 | 100 | 45 | -- | The mean maximal rate of purging in severe cholera exceeds 10 ml/kg/hour. Sodium losses in cholera stools exceed those seen in other causes of diarrheal illness. |
| Cholera stool, child | 100 | 30 | 90 | 30 | -- | ||
| Non-cholera stool child (ETEC) | 50 | 35 | 25 | 20 | -- | ||
| Intravenous Therapy | Lactated Ringer’s Solution | 130 | 4 | 109 | 28 | -- (278 if D5LR# available) | Lactated Ringer’s (LR) solution is usually readily available and preferred over normal saline because it contains potassium and bicarbonate. The optimal infusion, for cholera, such as ‘Dhaka solution’ contains more potassium and bicarbonate than LR and also contains dextrose; addressing complications of severe cholera including hypokaelemia hypoglycemia, and metabolic acidosis |
| Normal Saline | 154 | 0 | 154 | 0 | -- | ||
| Cholera Saline (Dhaka solution) | 133 | 13 | 154 | 48 | 140 | ||
| Oral Rehydration Therapy | ORS (WHO 2002)** | 75 | 20 | 65 | 10 (citrate) | 75 (glucose) | WHO ORS utilizes glucose as a carbohydrate source Rice based ORS formulation have been found in randomized trials to reduce the duration of diarrhea and stool losses in severe cholera (93) |
| Rice based ORS (eg. CeraORS 75®) | 75 | 20 | 65 | 10 (citrate) | 27 grams rice syrup solids | ||
| Home made ORS (135) | ~75 | 0 | ~75 | 0 | ~75 | ||
|
A home made preparation of ORS could be used in an emergency situation. | ||||||
Compositions are estimates of the mean electrolyte composition of stools and are shown to demonstrate the significant difference in the pathophysiology of pediatric and adult cholera and non-cholera childhood gastroenteritis.
Dextrose 5%-Lactated Ringer’s
In 2002, the WHO replaced its previous formulation of ORS with the current lower osmolarity formulation. Subclinical hyponatremia is common among cholera patients using the current WHO formulation of ORS (136;137), but the rates of symptomatic hyponatremia in cholera patients do not appear to be significantly increased (138).