5.9 Other comorbidities

Patients may have symptoms (e.g. fever) unrelated to cholera for which the cause must be determined (malaria, respiratory infection, etc.) and appropriate treatment provided. For management of these diseases, see Clinical guidelines, MSF.

Severe anaemia

In children under 5 years who present with signs of severe dehydration and severe anaemia (i.e. signs of cardiorespiratory distress), haemoglobin (Hb) should be measured.
– If Hb is ≥ 6 g/dl, follow the Treatment Plan C.
– If Hb is < 6 g/dl, follow the Treatment Plan C but without giving the bolus (90 ml/kg of RL as a continuous infusion over 4 hours; over 8 hours in severely malnourished children). In a separate IV line, start a blood transfusion1 . The blood volume administered should be deducted from the total volume of Plan C.

If Hb measurement and/or blood transfusion are not immediately available, follow the Treatment Plan C without giving the bolus (90 ml/kg of RL as a continuous infusion over 4 hours; over 8 hours in severely malnourished children). Anaemia will worsen temporarily due to dilution but it remains critical to re-establish an effective circulating volume.

Chronic cardiovascular diseases

In adult patients with chronic cardiovascular disease, the rehydration protocol does not change but closer monitoring for signs of fluid overload is required.


In diabetic patients, measure blood glucose every 6 hours, with a target of 140 to 180 mg/dl (7.8 to 10 mmol/litre). The standards of “tight control” in normal diabetic care are not necessary during cholera treatment, as long as potentially dangerous high or low levels of blood glucose are avoided.
Consumption of ORS should not be limited in an effort to control blood glucose level in both insulin- and non-insulin dependent diabetic patients.

Ref Notes
1 Packed red blood cells 15 ml/kg or whole blood 20 ml/kg administered over 3 hours.