DIARRHEAL DISEASES

File: 102596_sep96_decls2_0021.txt
Page: 0021
Total Pages: 28

Subject: DIARRHEAL DISEASES                                              

Unit: VAR. BUMED  

Parent Organization: BUMED       

Box ID: BX303811

Folder Title: VARIOUS NAVAL MESSAGES FOLDER 1                                                                 

Document Number:         16

Folder SEQ  #:          2









              E. INVASIVE PROCEDURE
                  1.  In presence of meningitis or suspected
                      meningococcemia, lumbar puncture for CSF should
                      be performed immediately, unless papilledema or
                      focal neurologic signs are present, suggesting
                      intracranial mass or increased intracranial pressure.
                  2.  CSF should be tested for glucose, protein, cell
                      count, gram stain and culture. Counter-immuno-
                      electrophoresis against meningococci, pneumococci,
                      and Hemophilus influenzae may be helpful if
                      available.
                  3.  CSF results:
                      a.  glucose = < 40 mg/dl (in 75% of cases)
                      b.  protein = i5O mg /dl (range 25-800)
                      C.  WBC - 1000 cells/nim, PMN predominant (range
                          10-65,000; lymphocyte predominance is seen in
                          < 10%).

              F. DIAGNOSTIC CONFIRMATION: Culture of organism from
                  clinical specimen (from blood, CSF, or petechial
                  aspirate).

       IV. DURATION:
            A.  TREATED: clinical response should occur within 48 hours.
                Duration of convalescence depends on severity of illness
                and its complications.
            B.  UNTREATED: Death may occur within minutes to hours.
                Mortality is extremely high.

       V. COMPLICATIONS:
                Shock, disseminated intravascular coagulation (DIC),
                adult respiratory distress syndrome (ARDS), pericarditis
                including tamponade, pneumonia, diabetes insipidus,
                cranial nerve palsies, prolonged mental status changes.

       VI. TREATMENT
            A.  Once meningococcal disease is suspected, treatment
                must proceed simultaneously with the diagnostic
                evaluation.
tory and physical exam, identifying
                contraindications to lumbar puncture.
                2.    Obtain blood for hemoglobin, chemistry, coagulation
                and   microbiologic studies; place IV line.
                3.    Perform LP if not contraindicated.
                4.    Administer antibiotics:
                      a) Penicillin G, 300,000 U/kg/day divided in 8 to
                      12 doses, to a maximum of 2 million units q2h IV, or
                      b) If Penicillin allergic: chloramphenicol 100 mg/
                      kg/day divided in 4 doses, to a maximum of 1 gm q 6h,
                      IV.
                5.    Provide hemodynaraic and respiratory support as
                      needed.
                6.    Proceed with more detailed history and examination;

Document 28 f:/Week-37/BX303811/VARIOUS NAVAL MESSAGES FOLDER 1/diarrheal diseases:1018961450003
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-37
Box ID = BX303811
Unit = VAR. BUMED
Parent Organization = BUMED
Folder Title = VARIOUS NAVAL MESSAGES FOLDER 1
Folder Seq # = 2
Subject = DIARRHEAL DISEASES
Document Seq # = 16
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 18-OCT-1996