Abstract
BackgroundCholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in patients with cholera.MethodsThis study was conducted on 191 patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the patients while their stay in the hospital and the data was analyzed on SPSS 15.0.ResultsOut of the 191 patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD±18.34). The average duration of symptoms was 3.75 days (SD±2.04). Of 191 patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer's Lactate (R/L) + Normal Saline (N/S), 45 (24%) patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD±16.6), mean creatinine was 2.47 (SD±2.35) and mean BUN/Creatinine ratio was 11.63 (SD±5.7).ConclusionAggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of >20∶1, patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of <15∶1.
Highlights
Cholera has long been known as a cause of diarrhea [1]
The objective of our study is to determine the Blood Urea Nitrogen (BUN)/ Creatinine ratio in cholera patients with dehydration and renal insufficiency and amount of fluid replacement therapy given in a tertiary care hospital in Pakistan
Medical charts were evaluated for baseline investigation including initial hydration status, BUN on admission, creatinine on admission, BUN/creatinine ratio on admission, severity of the illness on presentation, and in- hospital investigation which included 24 hourly fluid administration, types of fluid administrated, hydration status on discharge, BUN on discharge, creatinine on discharge, BUN/creatinine ratio on discharge, duration of hospital stay, causative agents, stool cultures and clinical outcome of the patients
Summary
Cholera has long been known as a cause of diarrhea [1]. The common symptom associated with cholera is acute, painless, voluminous, watery diarrhea and effortless vomiting, the diarrhea is sometimes referred as ‘‘rice water stools’’[7,8]. It is diagnosed by Stool culture and agglutination of vibrios with specific sera [9]. The objective of our study is to determine the BUN/ Creatinine ratio in cholera patients with dehydration and renal insufficiency and amount of fluid replacement therapy given in a tertiary care hospital in Pakistan. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in patients with cholera
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