Nutritional status: a determinant of severity of diarrhea in patients with cholera

Abstract

The severity of diarrhea and nutritional status were measured in a prospective study of 97 patients hospitalized with cholera in Dacca, Bangladesh. Ninety-five percent of both adults and children were below their respective medians in weight as related to height; greater than 15% of each group showed second-degree protein-calorie malnutrition. Duration of diarrhea, but no volume of stool per hour, was prolonged by 30%-70% in those adults and children suffering from more severe malnutrition. The increased stool loss was unrelated to antibiotic usage, to presence of intestinal parasites, or to the refeeding diet given. It is suggested that the prolongation of diarrhea represents the continued effect of cholera toxin that is irreversibly bound to intestinal mucosal cells, the replacement of which would be retarded under conditions of poor nutrition.

PIP: This study investigates the severity of cholera as related to status of protein-calorie nutrition in both tetracycline-treated and non-antibiotic-treated male patients (n=97) at the Cholera Research Hospital in Dacca, Bangladesh during the cholera epidemic of October through December 1974. Stool and urine samples were analyzed. 54 of the patients were severely dehydrated (plasma specific gravity, 1.034) and 43 were moderately dehydrated (plasma specific gravity, 1.030-1.034). Results show that 95% of both adults and children patients were below their median in weight as related to height and that more than 15% of each group showed 2nd degree protein-calorie malnutrition. Prolongation of diarrhea was marked in all patients. 30 to 70% increase in duration of diarrhea was seen in patients with severe malnutrition. Increased stool loss was not associated with antibiotic usage, presence of intestinal parasites, or to refeeding diet given. The findings show that malnutrition enhances risk of infection and particularly of diarrheal illness, which in turn produces more profound malnutrition. Increased stool losses and prolonged diarrhea in malnourished patients may result in large increases in fluid, electrolyte and nursing needs