Table 2.

Approach to rehydration in the patient with suspected cholera (67)

			Degree of Dehydration
		None (< 5%)	Some (5–10%)	Severe (>10%)
Clinical assessment for dehydration dehydration	General appearance Eyes Thirst	Well, alert Normal Drinks normally	Restless, irritable Sunken Thirsty, drinks eagerly	Lethargic or unconscious Sunken Drinks poorly or unable to drink
Approach to rehydration#	Skin turgor Pulse Requirement for fluid replacement	Instantaneous Recoil Normal Ongoing losses only	Non-instantaneous recoil Rapid, low volume 75 mL/kg in addition to ongoing losses	Very slow recoil (>2 seconds) Weak or absent >100 mL/kg in addition to ongoing losses
	Preferred route of administration Timing	Oral* Usually guided by thirst	Oral or Intravenous Replace fluids over 3–4 hours	Intravenous As rapidly as possible until circulation is restored, complete the remainder of fluids within 3 hours
	Monitoring	Observe until it is determined that ongoing losses can be adequately replaced by ORS	Observe every 1–2 hours until all signs of dehydration resolve and patient urinates	Once circulation is established monitor every1–2 hours.

^#Patients with co-morbid conditions including severe malnutrition, significant complications, infants and elderly patients may require adjustments from this standard which are detailed in the references.

^*If losses are in excess of 10 ml/kg/hour per hour, it may not be possible to successfully employ oral therapy initially. An excellent resource is the Cholera Outbreak Training and Shigellosis (COTS) Program (www.cotsprogram.com) that provides free online information regarding the management of patients with cholera, based on WHO standards.