Bibliographic information
Guideline—
Year of Publication—
Issuing Institution—
Recommendation
New
WHO recommends patients with suspected or confirmed filovirus disease with ongoing gastrointestinal fluid losses and some dehydrationa be treated with a protocolized oral rehydration regimen (e.g. WHO Plan B).
Recommended in favor
Strong
Certainty of evidence
Moderate
Notes and Remarks
- This recommendation applies to both children and adults, including pregnant women.
- Systematic monitoring of vital signs including fluid input and output is required to identify those patients that may need escalated treatment with intravenous fluid.
- Peripheral venous catheter should be placed in all patients with filovirus disease in case there is need to augment with intravenous fluids.
- This does not apply to patients with sepsis or septic shock, for which intravenous fluid therapy is indicated, nor those with severe acute malnutrition, for which other WHO guidelines should be used. a In children: Some dehydration is defined as no signs of severe dehydration, with two or more of the following signs: restlessness; irritability; sunken eyes; thirsty and drinks eagerly; skin pinch goes back slowly. Severe dehydration is defined as two or more of the following signs: lethargy or unconsciousness; sunken eyes; unable to drink or drinks poorly; skin pinch goes back very slowly (≥ 2 seconds). In adults: Some dehydration is less well defined than for children, but includes symptoms of: feeling thirsty; concentrated urine; infrequent urination; feeling dizzy or lightheaded; tiredness; dry mouth, lips and tongue; sunken eyes. Practical info Start fluids early to prevent and mitigate fluid losses and organ damage.
- For initial treatment give oral rehydration salts (ORS) 75 mL/kg in the first 4 hours of treatment.
- Give additional ORS to replace on going losses. Recommended after each loose stool:
- < 2 years 50–100 mL
- 2–9 years 100–200 mL
- ≥ 10 years and adults – as much as wanted. Further tools may be modified from those for cholera: Clinical tools for cholera treatment facilities.