DRHOOK- Gotta go: Diarrhea with cholera is what can kill

the handsome doctor John Hong

Good vibes? Bad vibes? Don't we all have a sixth sense at times? The problem is that sometimes we don't listen to our inner voice. We follow a slick vibe, like investing in Enron or hanging out with people who are more toxic than Love Canal in the ‘70s.

I watched a movie with Naomi Watts (good vibe!) and Edward Norton (even better vibe!) called The Painted Veil. I had no idea what the movie was about, but since I like these two actors, I watched it. Man, it was something! It features a cholera epidemic, and it reminded me of one of my medical school professors who talked about a cholera bed, a bed with a hole so the sick patient doesn't have to get up to use the toilet. 

Can diarrhea kill you?

Vibrio is not a good vibe, nor is it pronounced the same ("vib" rhymes with "bib"). Vibrio cholerae is bacterium that causes gastroenteritis (vomit and diarrhea) and has caused deadly epidemics throughout the course of history. 

Of the dozens of strains of Vibrio Cholerae, some are worse than others. For this discussion, let's focus on the bad boys. About 50-70 percent of people with untreated cholera die, usually from volume depletion during epidemics. You know a two-liter bottle of soda— that's how much fluid is lost in as little as two hours from diarrhea and vomiting. A person can lose his entire body weight in fluid in just two days!

"Rice water" is used to describe how the diarrhea appears at first from the flecks of mucus, and it has a fishy odor. Unlike dysentery, there isn't a fever, and the abdominal pains are not as severe. Diarrhea is most severe the first two days and usually resolves on day four to six.

"How dry I am, how dry I am, nobody knows...." Well, you can know how dry someone is. The mouth becomes dry, thirst increases, eyes become sunken, tears dry up, and mental status declines with dehydration. 

From all the diarrhea, electrolytes are lost in a major way that can cause suffering and death. Low potassium can cause cramps all over and an irregular heartbeat. So the World Health Organization recommends oral hydration solutions (ORS) containing glucose and potassium to help the ailing intestines absorb fluids. They are low in sodium (low osmolality) to prevent more diarrhea. Such concoctions as Pedialyte, Rehydralyte, CeraLyte, and Enfalyte are all low-osmolality drinks. Drinks like Gatorade, Apple juice, Ginger ale, Chicken broth, and Colas are not recommended because they're higher in sodium.

Use of ORS has decreased the mortality rate to less than 1 percent. If a person is too dehydrated or can't hold down oral fluids, IV fluids can be used. Antibiotics aren't used initially, believe it or not, but can be used after vomiting stops because they help reduce diarrhea.

So how does one prevent infection by Vibrio? First is to avoid eating raw shellfish. When traveling, "Don't drink the water" is good advice, unless it's bottled or boiled. Street-vendor food, though, is a bigger risk because contaminated feces get on the street, on the vendor food (so much for Julia Child's five-second rule), and into diners' GI systems. Uncooked foods like raw vegetables can turn your GI system into a V8 maker. 

Consider renting The Painted Veil. The movie is about more than cholera: it's about romance, seduction, betrayal, and humanitarian efforts. Watch it while eating dinner– just not when you're having cholera greens.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.