Cholera has an acute onset. Death can occur as early as 4-8 hours of onset if the disease is severe. In a day, an adult passes several liters of watery stools of typical fishy smell and rice-water color.
Dehydration is often moderate to severe.
Some patients are brought unconscious or semiconscious because of hypovolemia. Signs of shock including a low blood pressure, poor or imperceptible pulse, poor skin elasticity, and poor urine output are common.