DIARE ANAK

SMF ILMU KESEHATAN ANAK

RSUD DR PIRNGADI
DIARRHOEA

VOLUME OF WATER
IN THE STOOLS

LOOSE WATERY
2
 DIARRHOEA
- FREQ. ≥ 3X / DAY
- CHANGING OF CONSISTENCY
- WITH/ WITHOUT VOMITING
- WITH/ WITHOUT BLOODY STOOL

SEVERE
ACUTE WATERY DYSENTERY PERSISTENT
DIARRHOEA MALNUTRITION
FORM

< 14 DAYS BLOODY

DIARRHOEA > 14 DAYS
3
 PRACTICALY

-LIQUID STOOLS ≥ 3 X/ DAY

-WITH/ WITHOUT VOMITING
-WITH/ WITHOUT MUCOUS/
BLOOD IN THE STOOLS

GASTROENTERITIS 4
 CLASSIFICATION

1. AGE
2. ONSET
3. ETIOLOGY
4. SEVERITY
5. PATHOGENESIS
6. HOST DEFENCES
7. SOURCE OF INFECTION
8. EPIDEMIOLOGY
9. SITE OF PATHOLOGY
10. WHO ( 2OO5 ) 5
 MIKROORGANISMS

GASTRIC ACID

MULTIPLICATION

COLONIZATION
ADHERENT

ENTEROTOXIN - INVASION
- DAMAGE

HYPERSECRETION MALABSORPTION
HYPERPERISTALIS

COLONIC SALVAGE DIARRHOEA

6
PATHOGENESIS OF ACUTE INFECTIOUS DIARRHOEA
 LOSS OF WATER VIA STOOLS

DEHYDRATION

PLASMA WATER

FEVER HEMOCONCENTRATION HYPOVOLEMIA

SHOCK RBF* SYMPATH. DISCHARGE

COMA ARF** - HEART RATE

- VASOCONSTRICTION
* Renal Blood Flow
** Acute Renal Failure
 DEHYDRATION

VOLUME PLASMA SODIUM

-SOME DEHYDRATION • ISONATREMIA

= 5 - 10 % BB = 135 - 150 mEq/L
-SEVERE DEHYDRATION
= > 10% BB • HYPO/HYPER
NATREMIA
 DEGREE OF DEHYDRATION (WHO,2005)

NO SIGN OF SOME SEVERE

DEHYDRATION DEHYDRATION DEHYDRATION

CONDITION WELL, ALERT RESTLESS / LETHARGIC,

IRRITABLE FLOPPY, COMA
EYES NORMAL SUNKEN SUNKEN

THIRST NORMALLY, NOT THIRSTY, DRINK DRINKS POORLY

THIRSTY EAGERLY
SKIN TURGOR QUICKLY SLOWLY VERY SLOWLY

NB : 1. READING FROM RIGHT TO LEFT

2. CONSIDERED SEVERE OR SOME DEHYDRATION
IF TWO OR MORE OF THE SIGN ARE PRESENT
 METABOLIC ACIDOSIS
1.NAUSEA, VOMITING & ANOREXIA
2.DEPRESSION OF CNS (COMA,
CONVULSION)
3.ARTERIAL DILATATION  HYPOTENSION
4.CARDIAC CONTRACTILITY
5.HEART FAILURE
6.VENTRICULAR FIBRILLATION
7.O2 AFFINITY OF Hb  ANOXIA
8.KUSSMAUL BREATHING  HYPO-
CARBIA  vasoconstriction  Cerebral
Blood Flow  drowsiness
HOLLIDAY - SEGAR
 10 kg 100 mL / kg
10 - 20 kg 1000 mL + 50 mL/ kg
for each  10 kg
 20 kg 1500 mL  20 mL/ kg
for each  20 kg
 REHYDRATION

ORAL I.V.

ORS* • RINGER’S LA CTAT

( ORALIT@) • RINGER’S ACETATE

* Oral Rehydration Salts 15

PREVIOUS STANDART WHO ORAL
REHYDRATION SALTS (ORS)

1.ISOTONIC
2.Na+ equivalent with plasma (90 mEq/l)
3. GLUCOSE = 2 - 3%
4. K+ ( higher than plasma  20 mEq/l )
5. BASE  30 - 48 mEq/L
16
 INDICATION OF I.V FLUIDS
1. SEVERE DEHYDRATION WITH/
WITHOUT SHOCK
2. SEVERE DIARRHOEA
3. INTAKE BY MOUTH
4. GLUCOSE MALABSORPTION
5. ABDOMINAL DISTENTION /
PARALYTIC OBSTRUCTION
6. OLIGURIA / ANURIA FOR SEVERAL
HOURS 17
 A. NO SIGN OF DEHYDRATION
1. ORALIT
• < 2 years = 50 - 100 mL / x loose stool
• 2 – 10 years = 100 - 200 mL/ x loose stool
• older children : as much fluid as they want
2. GIVE THE CHILD MORE FLUIDS AND FOOD THAN
USUAL

TO PREVENT DEHYDRATION & MALNUTRITION

3. ZINC 10 – 20 mg/day…10 - 14 days

18
 B. SOME DEHYDRATION

ORALIT  75 mL/kg BW /3 a 4 hours

INDICATION

• Ringer’s Lactate
• Ringer’s Acetate
19
 C. SEVERE DEHYDRATION

100mL/ kgBW/3-6 hours

• < 1 years * initial  30 CC/kgBW/1 hours
* repletion 70 cc/kgBW/5 hours

•  1 years  * initial  30 cc/kgBW/ ½ hours

* repletion = 70 cc/kgBW/2½ hours
20
 ANTIMICROBIAL (WHO)

1. CHOLERA TETRACYCLIN 12,5 mg/Kg BW - 4 x a day

3 days
2. SHIGELLA DYSENTERI 5 mg TMP + 25 mg SMX/Kg BW - 2 x a day
5 days
3. AMOEBIASIS METRONIDAZOLE 10mg/Kg BW - 3 x a day
5 days
4. GIARDIASIS METRONIDAZOLE 5 mg / Kg BW - 3 x a day
5 days

21
• Studi Kasus
• Seorang anak laki-laki, usia 1 tahun 6 bulan datang
berobat dengan keluhan diare dan muntah-muntah.
Sudah berlangsung selama 2 hari, dan kurang lebih
sebanyak 6 kali per hari, satu kali ± ¼ gelas aqua. Ada
demam, muntah 2 – 3X per hari, masih dapat minum.
Diare cair tanpa darah/lendir, berbau asam, berbuih,
perut anak kembung, dan daerah sekitar anus
berwarna kemerahan. Anak menjadi agak rewel dan
mengeluh haus.
 
 • Hasil penilaian yang ditemukan pada keadaan
tersebut adalah :
• Pemeriksaan fisik menunjukkan kesadaran baik, anak
nampak kehausan, tidak demam, cubitan kulit
kembali perlahan, mata kelihatan lebih cekung,
capillary refill < 2 detik. Berat badan 11 kg, padahal
sebelum kena serangan diare berat badan anak 12 kg.
• Nadi 102 x/i reguler,isi cukup, RR 20x/i,reguler,
temp 37° C
DISKUSI

• Apa diagnosis pasien tersebut

• Pemeriksaan penunjang yg dilakukan selanjutnya
• Tata laksana pasien tsb
• Edukasi pada ortu
•TERIMA KASIH