Cholera-like syndrome

　　It is now believed that this syndrome is caused by Clostridium difficile infection, and it can be induced in some severely ill patients, trauma, surgery, stress, and the use of broad-spectrum antibiotics. The exotoxin produced by Clostridium difficile can cause thrombosis, thrombosis, necrosis of the intestinal wall, and even perforation in small blood vessels; while the toxin stimulates the cAMP system in the mucosal epithelial cells, causing cholera-like symptoms.

　　1. Toxic megacolon, characterized by high fever, tachycardia, low blood pressure, drowsiness, and systemic failure; rapid abdominal distension with tenderness, tympanic percussion, weak or absent bowel sounds, and occasional massive lower gastrointestinal bleeding. When abdominal tenderness, rebound tenderness, and muscle tension occur, it often indicates acute perforation. Laboratory tests show significantly increased total white blood cell count and neutrophil count, left shift, and the appearance of toxic granules. Anemia, hypoalbuminemia, hypokalemia, and hypocalcemia and hypomagnesemia, dehydration, and other conditions are common. Abdominal X-ray film shows segmental or total colonic dilation, with the transverse colon and splenic flexure being most obvious.

　　2. Paralytic ileus, characterized by marked abdominal distension and often accompanied by vomiting of gastric contents, without fecal smell in the vomit. Patients cannot sit up and feel short of breath. Due to the loss of a large amount of body fluids, they feel extremely thirsty and the urine output decreases. Physical examination: abdominal distension, abdominal breathing disappears, no intestinal patterns or peristaltic waves can be seen; abdominal tenderness is not significant; percussion sounds are uniform tympanic, the liver dullness border is reduced or disappears; during auscultation, bowel sounds are significantly weakened or completely disappear.

　　3. Intestinal perforation. Perforation site and cause should be clearly identified during the diagnosis process to guide treatment. Intestinal perforation can be diagnosed based on medical history, symptoms, signs, and X-ray examination, which can detect free gas under the diaphragm, abdominal ultrasound, CT, and other examinations are not difficult.

　　This syndrome is mainly characterized by diarrhea, mostly watery diarrhea with mucus. In severe cases, the amount of feces per day can reach 4000ml. Some patients may excrete characteristic pseudomembranes. Diarrhea is not related to the dose or duration of medication. Abdominal pain, nausea, vomiting, and other gastrointestinal symptoms may occur, and there is often fever, tachycardia, and even dehydration, shock, acidosis, delirium, and other toxic symptoms.

　　Actively preventing infection after surgery is a good measure to prevent this disease. It often occurs in summer and autumn, and may have a history of unclean diet. The lesion mainly occurs in the jejunum or ileum, and the condition should be closely observed immediately, with blood pressure, respiration, pulse, and body temperature measured. If the blood pressure drops and the pulse becomes rapid, prepare intravenous infusion supplies immediately and execute the treatment as instructed. Take active preventive measures.

　　Prevent and treat dehydration.

　　1. In patients with mild dehydration, oral rehydration is the main treatment.

　　2. Medium and severe dehydration patients need to be treated with intravenous fluid resuscitation immediately, and oral rehydration can be changed after the condition stabilizes.

　　1. Laboratory examination:Peripheral leukocytosis, mainly neutrophils.

　　2. Endoscopic examination:Timely endoscopic examination can not only make an early and clear diagnosis but also understand the extent and range of the lesions. In mild cases, mucosal congestion and edema can be seen, and the vascular pattern is unclear. In slightly severe cases, superficial erosion of the mucosa can be seen, with pseudo-membrane spots distributed, peripheral congestion, and in severe cases, pseudo-membrane plaques or map-like patterns can be seen.

　　3. X-ray examination:Abdominal X-ray, barium enema examination.

　　1. Foods that are good for the body in cholera-like syndrome:

　　Diet should be light, nutritious, and easy to digest.

　　2. Foods to avoid for acquired platelet dysfunction:

　　Avoid spicy and刺激性 food.

　　In addition to supportive and symptomatic treatment, the original antibiotic should be discontinued, and lactic acid bacteria, bifidobacteria, and other probiotics should be used to support normal intestinal flora. Lizhuyangchang (Lizhu Enterol) 100 million units can be taken 2.0 times a day, divided into 4 doses, to treat Clostridium difficile, usually for 7-14 days. Additionally, metronidazole treatment is also effective.

　　I. General treatment

　　China's 'Law on the Prevention and Treatment of Infectious Diseases' lists this disease as a Class A infectious disease, so patients should be strictly isolated until 6 days after symptoms disappear and pathogenic bacteria are negative in three consecutive stool cultures. All excretions and utensils of the patient must be thoroughly disinfected. Patients can be given liquid food, but those with severe vomiting should be fasting. During the recovery period, diet should be gradually increased. Severe patients should pay attention to keeping warm, oxygen therapy, and monitoring vital signs.

　　II. Rehydration therapy

　　Rational rehydration is the key to treating this disease. The principles of rehydration are: early, rapid, and sufficient; first salt, then sugar; first fast, then slow; correct acidosis and supplement calcium; and replenish potassium when urinating.

　　1. Intravenous rehydration therapy can use a 5:4:1 solution, which means 5g of sodium chloride, 4g of sodium bicarbonate, and 1g of potassium chloride per liter of fluid, plus 20ml of 50% glucose; or a 3:2:1 solution, which is 3 parts of 5% glucose, 2 parts of normal saline, 1 part of 1.4% sodium bicarbonate solution, or 1 part of 1/6mol/L lactate solution. The amount and speed of fluid administration should be determined according to the degree of dehydration, blood pressure, pulse, urine output, and hematocrit. In severe cases, the initial rate can reach 50-100ml per minute, with a total intake of 3000-4000ml, 4000-8000ml, and 8000-12000ml respectively for mild, moderate, and severe dehydration. The fluid administration volume for children should be calculated based on age and weight, generally 100-180ml/kg/24 hours for mild to moderate dehydration. During rapid fluid administration, it is necessary to prevent heart failure and pulmonary edema.

　　2. Oral rehydration therapy is suitable for patients with cholera, as their intestines have poor absorption of sodium chloride, but they can still absorb potassium and bicarbonate, and glucose absorption is not affected. Moreover, the absorption of glucose can promote the absorption of water and sodium. Therefore, oral rehydration can be provided for patients with mild to moderate dehydration. The formula for oral rehydration solutions includes:

　　(1) Each liter of water contains 20g of glucose, 3.5g of sodium chloride, 2.5g of sodium bicarbonate, and 1.5g of potassium chloride;

　　(2) Each liter of water contains 24g of glucose, 4g of sodium chloride, 3.5g of sodium bicarbonate, and 2.5g of potassium citrate. For adults with mild to moderate dehydration, 750ml per hour is taken in the first 4 to 6 hours, and 250ml per hour for children weighing less than 25kg. After that, the amount is increased or decreased according to the amount of diarrhea, generally calculated as 1.5 times the amount of liquid for each stool excreted, or the method of giving as much as they can drink can also be adopted. For severe cases, infants, and elderly patients, intravenous fluid replacement should be given first, and then oral fluid replacement can be changed after the condition improves or vomiting subsides.

　　Third, pathogen treatment

　　Early administration of antimicrobial agents can help shorten the diarrhea period, reduce the amount of diarrhea, and shorten the time of excretion. Tetracycline can be selected first, with 0.5g taken every 6 hours for adults; for children, 40-60mg/kg/day is calculated, divided into 4 times for oral administration, and the course of treatment is 3-5 days.

　　For patients infected with tetracycline-resistant strains, doxycycline 300mg per dose can be taken once a day. Other drugs such as norfloxacin, erythromycin, sulfonamides, and furazolidone are also effective. Berberine not only has a certain effect on Vibrio but also can delay the toxicity of enterotoxins and can also be used.

　　Fourth, symptomatic treatment

　　For severe vomiting and diarrhea, 0.5mg of atropine can be injected subcutaneously, and 100-300mg of hydrocortisone can be administered intravenously as appropriate, or acupuncture at Dalin, Tianshu, Neiguan, and Zusanli. Early use of chlorpromazine (1-4mg/kg) has an inhibitory effect on intestinal epithelial cell AC, which can reduce the amount of diarrhea.

　　For muscle spasms, local hot compress, massage, or acupuncture at Chengshan, Yanglingquan, Quchi, and Shousanli may be given, and attention should be paid to the supplementation of sodium and calcium agents.

　　For oliguria, hot compress on the renal area, short-wave diathermy, and diuretic mixture intravenous infusion may be given; if there is no urine, 20% mannitol and furosemide treatment may be given, and if ineffective, it should be treated as acute renal failure.

　　For patients with concurrent heart failure and pulmonary edema, ouabain K or digitalis preparation should be administered, and other treatment measures should be taken.

　　For patients with severe dehydration and shock, if the circulation is not improved after sufficient expansion and acid correction, vasopressor drugs such as dopamine and aramine may be applied as appropriate.