Diarrhea Tx

[path800]

A 17-year-old boy comes to the emergency
department because of severe thirst and
weakness and a 4-kg (8.8-lb) weight loss
over the past 36 hours. He began having
voluminous painless watery diarrhea on the
airplane while returning from a trip to
Thailand 36 hours ago. He has not vomited.
While supine, pulse is 110/min and blood
pressure is 110/60 mm Hg. While standing,
pulse is 170/min and blood pressure is
70/40 mm Hg. His abdomen is nontender
and bowel sounds are increased. Which of
the following treatments is most appropriate
at this time?
(A) Ciprofloxacin
(B) Doxycycline
(C) Exploratory laparotomy
(D) Potassium chloride
(E) Rehydration
(F) Trimethoprim-sulfamethoxazole

Seem to be cholerae infection. Ans is E. Why not D? The first sentence said he has weakness. I thought he needs to receive both potassium and water.

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[notbobtrustme]

he has weakness because he's been blowing liquids out his butt for the past 2 days.

rehydration will correct all the problems until he can clear the cholera toxin

 

[MilkIsGood]

dont think so hard. cholera = rehydrate

 

[CherryRedDracul]

Rehydration = mix of electrolytes, liquids, and sugars. If you treated him with potassium chloride with rehydrating first, you risk putting him in a hyperkalemic state.

People with diarrhea lose bicarbonate and K+ (and all the other electrolytes), and in severe cases such as in cholera, there is often enough bicarbonate lost to cause metabolic acidosis. And one of the ways the body compensates for metabolic acidosis is by sucking H+ into cells in exchange for K+. So K+ concentration appears to be in the normal range despite heavy total body losses. Adding more potassium on top of that puts the patient at risk for hyperkalemia unless you rehydrate first. After rehydration, you may see the hypokalemia emerge and then you can correct it.

But first step should be rehydration.

 

[Handinhand]

Just FYI -- Potassium Chloride is what they use to end someone's life during lethal injection. You sure you want to give that to a kid who's dehydrated?