How should I manage a patient with suspected cholera who presents with severe dehydration?

Management of a patient with suspected cholera presenting with severe dehydration involves prompt and effective rehydration therapy.

Start with rapid intravenous fluid therapy using isotonic solutions such as 0.9% sodium chloride or 0.9% sodium chloride with 5% glucose to replace fluid deficits and maintain hydration, especially if shock is suspected or confirmed.

Administer an initial rapid intravenous infusion of 10 ml/kg of 0.9% sodium chloride solution; if shock persists, repeat the infusion immediately and consider other causes of shock.

Once shock resolves, continue rehydration with intravenous fluids, adding 100 ml/kg for fluid deficit replacement to maintenance fluids if initial shock was present, or 50 ml/kg if not shocked at presentation, while monitoring clinical response and plasma electrolytes (sodium, potassium, urea, creatinine, glucose).

Measure plasma sodium frequently, especially if hypernatraemic dehydration is suspected, and replace fluid deficits slowly over approximately 48 hours to avoid rapid sodium shifts.

Attempt early and gradual introduction of oral rehydration solution (ORS) during intravenous therapy; if tolerated, stop intravenous fluids and complete rehydration orally using low-osmolarity ORS solutions.

After rehydration, encourage continued fluid intake including breastfeeding or milk feeds, avoid fruit juices and carbonated drinks, and consider giving 5 ml/kg ORS after each large watery stool in patients at increased risk of recurrent dehydration.

Administer antibiotics specifically for cholera as per specialist advice, since antibiotic therapy is indicated in cholera cases.