5.5 No dehydration (or maintenance therapy)


Maintenance therapy is used for both:
– Patients dehydrated on admission who have been rehydrated and present no further signs of dehydration;
– Patients with no dehydration on admission.

5.5.1 Treatment protocol (Plan A)

Maintenance therapy

Administer ORS after each loose stool, until diarrhoea stops, as indicated below:

Table 5.5 – Quantity of ORS to maintain hydration (WHO)

Age

Amount of ORS
after each loose stool

ORS quantity per day
Under 2 years50-100 ml (10-20 teaspoons of 5 ml)500 ml/day
2 to 10 years100-200 ml (½ to 1 glass of 200 ml)1000 ml/day
Over 10 yearsat least 200-250 ml (at least 1 glass of 200 ml)2000 ml/day

Complementary therapy

Zinc sulfate PO for 10 days for children under 5 years (Appendix 7). See also Section 5.6 for instructions for home therapy.

5.5.2 Patient supervision

Patients who have completed rehydration

Patients who commence maintenance therapy after having completed oral or IV rehydration should be observed for 4 to 6 hours before discharge.

Patients with no dehydration on admission

Patients with no dehydration, though counted as a case of cholera, do not necessarily require hospitalisation to receive maintenance therapy.
However, patients who are at risk (of deterioration or complications) should be observed over 4 to 6 hours:
– Children under 1 year of age;
– Patients who vomit;
– Malnourished children (malnutrition suspected or known);
– Patients who live far away from the treatment facility.

Non-dehydrated patients who do not fall into these risk categories can have the 4 to 6 hour observation period shortened (e.g. 1 to 2 hours) if they:
– Can drink ORS without vomiting;
– Can easily return to the treatment site if their condition deteriorates;
– Have received and understood the instructions for therapy at home.

Surveillance

Verify that the patient consumes ORS correctly after each stool. Every hour:
– Check on the patient’s state of hydration.
– Record on the patient file the amount of ORS consumed and the number of episodes of diarrhoea and vomiting.

Give particular attention to patients who are not autonomous (e.g. young children, the elderly), have abundant diarrhoea or vomiting, or who have difficulty drinking as these patients are at an increased risk of becoming dehydrated.

Spend more time with those who are vomiting or have difficulties in following the treatment plan.

Vomiting (that is not repetitive or systematic with each intake of ORS) is not a contraindication to oral therapy. Vomiting can be induced or aggravated by rapid consumption of more ORS than the stomach can tolerate. Show how to administer ORS in smaller quantities to avoid vomiting (Section 5.4.3). IV therapy is not indicated in patients who vomit but continue to have no signs of dehydration.

At any time, if signs of dehydration appear, switch to the protocol best adapted to the degree of dehydration.