The disease usually presents after one to five days after infection, with explosive, painless, large-volume diarrhoea. Passing 15 litres of diarrhoea a day is not unusual, and is the reason why patients rapidly go into shock, especially if they start vomiting, which is also common, and are unable to catch up with oral fluids. Cholera organisms release a toxin on attaching to the gut. The toxin, via a complex process, results in the body failing to absorb salt. The salt in turn drags water out of the cells lining the gut, hopelessly overwhelming the gut's reabsorption mechanisms.
Medical treatment replaces the water and salts lost in the diarrhoea.
This is preferably done orally, with a mixture of water, salts and sugar. If the patient is vomiting or if the stool volume is catastrophic, intravenous salt-containing solutions are used. This is a problem, as intravenous preparations are expensive, often out of the reach of poor countries. Death can occur within five hours in children. Antibiotics may be used to decrease the time the patient has diarrhoea, but the fluid replacement is much more important.