UMEM Educational Pearls

Category: International EM

Title: Cholera

Keywords: International, Diarrhea, Infectious diarrhea (PubMed Search)

Posted: 10/31/2012 by Walid Hammad, MD, MBChB
Click here to contact Walid Hammad, MD, MBChB


Diagnosis should be considered in any individual over 5 years old with severe dehydration from diarrhea, regardless of exposure to an endemic area, and any patient over 2 years old with watery diarrhea in an endemic area. 

Patients with severe cholera can stool as much as 1 L an hour.  Replacing fluids is the most important part of treatment with oral rehydration being used as soon as possible.  Oral rehydration therapy  provides better potassium, carbohydrate, and bicarbonate replacement than most IV fluid solutions.  Antibiotics will also decrease volume and duration of stooling but are only recommended in moderate to severe illness.  Antiemetics are not useful because they can make patients sleepy and will reduce their ability to rehydrate orally.  Antimotility medications will prolong the duration of illness. 



University of Maryland Section for Global Emergency Health

Author:  Jenny Reifel Saltzberg




Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB. Cholera. Lancet. 2012 Jun 30;379(9835):2466-76.