Signs indicating severe dehydration in a cholera patient are dramatic and require urgent intervention. Key indicators include a patient who is lethargic or unconscious, has sunken eyes, is too weak to drink, and has skin that, when pinched, retracts very slowly ("tenting"). These symptoms signal a critical loss of circulatory volume.
The management for this stage is immediate, aggressive intravenous (IV) rehydration with a balanced solution like Ringer's Lactate. Oral rehydration is no longer sufficient because the gut may not absorb fluid fast enough, and the patient is often too weak to drink adequate amounts.
Prompt fluid replacement is critical for survival because the massive fluid loss leads to hypovolemic shock. In this state, blood pressure plummets, and vital organs like the kidneys and brain are deprived of oxygen and nutrients. This can cause irreversible kidney failure, cardiac arrest, and death within hours. Rapid IV fluids directly refill the circulatory system, reversing shock and restoring blood flow to organs, making it the single most life-saving intervention.