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

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.