DIARRHOEA (PEDIATRIC)

Document Number : Revisi Page

MUH/EMT/SPO/B.17 0 1/3

Established Date : Set by :

SOP February 19th 2019 Muhammadiyah Headquarter

Definition Diarrhoea is the passage of 3 or more unformed stools in 24 hours.

Purpose Provide instructions for health workers which will help identify the
signs and symptoms to permit early treatment.

Procedure 1. The diagnosis is made on the basis of a history of watery

diarrhoea, bloody diarrhoea, or other forms of diarrhoea of
recent onset accompanied by weight loss, corresponding to fluid
loses since the onset of diarrhea.

2. Assess for dehydration.

A B C
General Well, alert Restless, irritable Lethargic or
condition unconsciousness
Eyes Normal Sunken Sunken
Thirst Drinks normally, Thirsty, drinks Drinks poorly, or
not thirsty eagerly not able to drink
Skin pitch Goes back Goes back slowly Goes back very
quickly slowly
Decision NO SIGNS OF If 2 or more signs If 2 or more signs
DEHYDRATION in B: SOME in C: SEVERE
DEHYDRATION DEHYDRATION
Treatment Plan A Plan B Plan C
(Home treatment) (EMT type 1) (Referral)
- Give ORS (oral - Give ORS, zinc - Urgent referral
rehydration supplements and -Consider
solution), zinc food to treat stabilisation with
supplements and diarrhoea at EMT nasogastric tube
food to treat level. or IV line before
diarrhoea at - Weigh the referral.
home. patient. - Informed the
- Advise mother - Advise mother EMTCC / local
when to return to continue health authorities
immediately. breastfeeding. to obtain the
-If treatment fails, faeces sample.
consider to obtain
an IV access and
refer to a higher
level.
- Informed the
EMTCC / local
health authorities
to obtain the
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faeces sample.
3. If a patient has a significant diarrhoea (very frequent or
abundant stools) but is not dehydrated, administer specific ORS
(oral rehydration solution), after each watery stool, to avoid
dehydration.
4. If the patient has no profuse diarrhea, give plain water after each
loose stool.
5. In case of hypovolemic shock (weak and rapid or absent radial
pulse, cold extremities, CRT ≥ 3 seconds, whether or not
consciousness is altered), in a child with diarrhea or
dehydration:
- Place an IV line and administer 10 mL/kg of 0,9% NaCl
over 30 minutes, under close medical supervision.
- Administer oxygen (2 litres minimum).
- Insert nasogastric tube or orogastric tube, if needed.
- Every 5 minutes, evaluate clinical response (recovery of
consciousness, strong pulse, CRT < 3 seconds) and check
for signs of over-hydration.
- If the clinical condition has improved after 30 minutes,
switch to the oral route using 5 mL/kg every 30 minutes for
2 hours.
- If the clinical condition has not improved, administer again
10 mL/kg of 0,9% NaCl over 30 minutes then, when the
clinical condition has improved, switch to the oral route as
above.
- When switching to oral route, stop the infusion but leave the
catheter (capped) in place to keep a venous access.
6. If the clinical condition has still not improved, refer to a higher
health facility.
7. Persistent diarrhea (>14 days) should be referred.
8. Suspect cholera in any person > 2 years old who have acute
diarrhea and signs of severe dehydration or shock, if cholera is
present in the area. Notify public health authorities immediately.

Algorithm for diarrhoea

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Relation Unit 1. Medical personnel members of the EMT.

2. Medical logistic of EMT
3. MDMC
4. MPKU
5. Central Board of Muhammadiyah

References - Pudjiadi, A. H., Hegar, B., Handryastuti, S., Idris, N. S.,

Gandaputra, E. P., dan Harmoniati, E. D. Pedoman Pelayanan
Medis Ikatan Dokter Anak Indonesia. 2009.
- Tintinalli, J.E, Stapczynski, J. S., et al. Tintinalli’s Emergency
Medicine: A Comprehensive Study Guide, 8th edition, 2016.