1 / 12

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.

adelaidee
Download Presentation

Clinical Cholera Case Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related