How should I manage a patient with Shigella infection who presents with severe dehydration?

Management of a patient with Shigella infection presenting with severe dehydration involves:

• Immediate assessment and recognition of dehydration severity and shock: Look for signs such as altered responsiveness, decreased urine output, pale or mottled skin, cold extremities, sunken eyes, dry mucous membranes, tachycardia, tachypnoea, weak peripheral pulses, prolonged capillary refill time, and hypotension to identify clinical dehydration or shock ¹.
• Initiate intravenous fluid therapy urgently if shock is suspected or confirmed: Administer rapid intravenous boluses of 10 ml/kg 0.9% sodium chloride solution, repeating once if shock persists, and consider other causes if no improvement ¹.
• After stabilizing shock, continue intravenous rehydration: Use isotonic fluids such as 0.9% sodium chloride or 0.9% sodium chloride with 5% glucose for fluid deficit replacement and maintenance, adjusting volume based on shock status (100 ml/kg plus maintenance if shocked; 50 ml/kg plus maintenance if not shocked) ¹.
• Monitor plasma electrolytes and biochemistry: Measure sodium, potassium, urea, creatinine, and glucose at baseline and regularly during intravenous therapy, adjusting fluids and adding potassium supplementation as needed ¹.
• Attempt early and gradual introduction of oral rehydration therapy (ORS) during intravenous therapy: If tolerated, switch to ORS to complete rehydration ¹.
• After rehydration: Encourage breastfeeding or normal milk feeds, fluid intake, and reintroduction of usual solid foods; avoid fruit juices and carbonated drinks until diarrhoea resolves ¹.
• Antibiotic therapy: Give antibiotics for dysenteric shigellosis (Shigella infection with blood in stools) as per guidelines, since Shigella is a cause of dysentery ¹.
• Do not use antidiarrhoeal medications.