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. Sings of shock including a low blood pressure, poor or imperceptible pulse, poor skin elasticity, and poor urine output are common.