The best medical advice to survive Ebola now may fit in one
word: drinks.
With targeted drugs and vaccines at least another month,
doctors and public health officials learned of Ebola victims what simple steps
to help them defeat the infection. It turns out that drinking 4 liters (1
gallon) or more daily rehydration solution - a challenge for anyone and
especially those wracked by relentless attacks of vomiting - is very important.
"When a person is infected, they get crispy dry really
quickly," said Simon Mardel, an emergency room physician advising the
World Health Organization Ebola in Sierra Leone. "Then the tragedy is that
they do not want to drink."
Aggressive fluid replacement is considered important in
saving two American health care workers with Ebola at Emory University Hospital
in Atlanta, according to a study published in the New England Journal of
Medicine last week. Interview WHO Mardel and colleagues conducted with six of
the dozen patients who survived Ebola in Nigeria, where the ratio is much lower
mortality, also show the importance of drinking. There Igonoh, a doctor who was
caught Ebola in late July while working at the Hospital of the First Consulting
in Lagos, said he was taking oral rehydration salts, or ORS, water mixed in her
gastrointestinal symptoms begin immediately - even before his diagnosis of
Ebola. Once hospitalized, he trawled the internet on his iPad to insights from
the victim.
Learning in exile
"I know that in diarrhea, shock of dehydration is the
number one cause of death," said Igonoh in an e-mail. "From the
results of my research on Ebola while in isolation, I found that to be
true."
WHO together with transcripts of interviews with Igonoh and
five other Ebola victims with patient permission to provide insight into the
clinical and management experience. Igonoh also answer follow-up questions in
an e-mail directly.
Patients in Liberia lost 5 liters of fluid a day of diarrhea
alone, there are doctors who treat cases of paper to write on November 5 in the
New England Journal of Medicine.
Severe fluid loss can cause a kind of shock that prevents
the heart from pumping enough blood to the body, eventually causing multiple
organ failure.
"When I took the ORS and treated dehydration, it gives
me energy, and my immune system is able to fight the virus," said Igonoh
29 years.
simple message
Patients become "riveting dehydrated" because they
do not feel like eating or drinking in the early stages of disease, and then
they lose liters of fluid from profuse sweating, vomiting and diarrhea,
according to Mardel.
"You do not want to drink, then you are too weak,"
he said in a telephone interview from Freetown. "In the last stage, you're
in shock and your gut is closed."
Mardel been working on medical aid and emergency relief
operations for 30 years, including the response to an outbreak of Lassa fever
in Sierra Leone, Ebola in Uganda and Marburg virus disease in the Democratic
Republic of Congo.
Death can be reduced by providing a simple message about the
importance of taking fluids and choose painkillers right, he said.
Acetaminophen, the active ingredient in Panadol, is the drug of choice for pain
and fever, and choose others such as aspirin and ibuprofen can aggravate
bleeding, he said.
"We will divide the number of deaths by first simply
stop the anti-inflammatory and provide hydration, and really pushing it,"
said Mardel. "I want every man and woman in Sierra Leone to know this. I
want sports figures who will talk about it. I want people to talk about
it."
Ebola blueprint
In Nigeria, 40 percent of them are known to have been
infected died. In the whole of West Africa, the mortality rate of about 70
percent.
The success of Nigeria to stop Ebola shows how the virus can
be labeled and a blueprint for other developing countries are at risk of the
disease, the WHO said after declaring the country's most populous-Ebola-free
last month in Africa.
Liberian-American Patrick Sawyer introduced Ebola to Nigeria
in July when he arrived on a flight to Lagos, a city with about 21 million
people, according to WHO. Besides Sawyer, five health workers and a protocol
officer who received him at the airport died of Ebola, according to Nigeria's
health ministry. Twelve survived.
Learn from their experiences and put the lessons that used
in West African countries other is key, because too many patients arrive at treatment
centers are very dry and difficult to rescue, Mardel said.
spurning care
Patients usually seek medical assistance after five days of
illness, according to a case study of Ebola in Conakry also published Nov. 5 at
the New England Journal of Medicine.
"More than eight to 10 days of sick, you will need to
maybe 40 liters of fluid," said Mardel. "Day after day, if you do not
get it, we can not suddenly give 20 liters to catch up."
Fluid deficit and "profound electrolyte chaos"
seems to increase the risk of death, the WHO said in a November 6 statement. In
that document, the Geneva-based agency recommended intravenous rehydration. Not
everyone agrees that the delivery service is the best way to go. Oral
rehydration, which is taken in the intestine, seems to help patients maintain a
better balance of electrolytes, according Mardel.
Do not swallow
Most of intravenous rehydration solution also does not have
a lot of potassium, calcium, or magnesium, doctors at Emory University Hospital
wrote in their journal article last week. They recommend complete oral
rehydration with third, especially in patients with large volume diarrhea.
However, the drink has a challenge. Patients must overcome
recurrent nausea and debilitating joint pain that can make gripping and
movement difficult.
Ebola survivors Fadipe Akinniyi Emmanuel, another doctor at
the First Hospital Consultants where Igonoh work, said swallowing rehydration
solution made him sick.
"Every time I tried to take the ORS, I threw up,"
he told the WHO, according to the transcript. Finally, Emmanuel found he could
keep down 4 liters of fluid per day by taking frequent, small sips of nausea.
He did not respond to two e-mails asking follow-up questions.
Flavoring liquids also helps. The granules were co Emmanuel
Igonoh take home the flavors of orange and a lot more fun than the kind of
bland he was given in the hospital, he said.
"I had to force myself mentally," he said,
according to a transcript.
Igonoh used less than rehydration salt per liter of water
than recommended because the drinks are more dilute easier to stomach, help him
to improve intake, he said.
"You do not want to drink anything," said Igonoh.
"You're too weak." That's when the spirit is key, said the doctor,
who now sports a shaved head after a viral disease caused most of her hair to
fall out. "You have to be able to say to yourself, no matter how many
people died, you will survive. And you will survive."
Bloomberg
Sumber : http://thejakartaglobe.beritasatu.com/
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