Problem analysis

A 1-year-old girl came with a chief complaint of liquid stool mixed with mucus and
blood and secondary complaints is vomiting. From anamnesis Since 3 days before hospitalized
patientss defecation is liquid liquid , frequency > 4 times / day, volume starfruit cup, liquid>
pulp, no blood, no mucus, no nausea and vomiting , there are sudden high fever, no cough, no
runny nose, no seizures, no shortness of breath, urination within normal limits, patient still want
to drink and eat but the amount and frequency is diminishing, then the patient was taken to the
midwife and then given zinc and paracetamol but no improvement. Since 6 hours before
hospitalized patientss defecation is liquid stool mixed with mucus and blood, colour is fresh red
blood, frequency > 7 times / day, volume starfruit cup, liquid> pulp, patient looked pain every
want defecate, nausea and vomiting (+), the frequency of vomiting one time, the contents of what
to eat, vomiting not projectile, volume starfruit cup, children looked fussy and still want to eat
and drink, the tears (+), there are fever but not so high, no cough, no runny nose, no seizures, no
shortness of breath, urination within normal limit , the patient was brought to the GP clinic then
referred to RSMH.
From alloanamnesis obtained for defecation without mucus and blood from three days
ago, the patient was taken to the midwife and then given paracetamol and zinc but no
improvement, then 6 hours before hospitalized obtained patient defecation is liquid stool with
mucus and blood, fresh red blood frequency > 7 times, volume starfruit cup, the patient looked
pain during defecation, vomiting and fever is not too high. These symptoms indicate that
diarrhea may occur due to the infection (dysentery). This phenomenon is found less than 14 days
so its mean acute. Acute diarrhea is that defecation with liquid or mushy stool with / without
mucus or blood, with a frequency of 3 times or more a day, lasts not more than 14 days, less than
4 episodes / month
On a physical examination found signs of dehydration are a fussy patients condition,
sunken eyes, tears (+), large fontanel is concave, skin turgor back in > 2 seconds, dry mouth
mucosa and children still want to drink. But signs of circulatory disorders such as pulse and rapid
breathing, cold akral extremities and lethargy was not found. Based on these symptoms, the
degree of dehydration in these patients categorized as mild to moderate. On physical examination
also found signs of abdominal bowel sounds were increased and tenderness
Nutritional status of these patients showed a good nutritional state that is based on the WHO
curves BB / PB is between the (-1 SD) - (-2 SD). In the laboratory tests showed an increase in
leukocyte levels above normal or leukocytosis is 17,700 / mm3 indicating the presence of
bacterial infection process.
Based on alloanamnesis, physical examination and laboratorium result, so diagnosis is
acute diarrhea ec susp. shigellosis with mild-moderate dehydration + Failed Oral Rehydration
efforts. And differential diagnosis in this case is an acute diarrhea e.c suspt amoeba infection

with mild dehydration + Failed Oral Rehydration efforts. To be exact diagnosis then required
continues investigations such as routine urine examination, routine stool and stool culture.
Management of these patients with fluid therapy to replace fluids and electrolytes lost
and maintain the amount of fluid and electrolyte body by giving oralit 75cc / kg / 4 hours until
the thirst is missing then when reached rehydration fluids continued with maintenance, oralit 1020cc / kg. However, when oral rehydration efforts is fails, where the child vomited when given
oralit, can do intravenous fluid replacement of RL 75cc / kg / 4 hours. Antimicrobial / antibiotic
can be given to patients because, in the department of children Gastrohepatologi RSMH
palembang guideline clinical finding suspected Shigella (any diarrhea accompanied by blood can
be considered shigellosis, if there is no typical clinical signs for other diseases or other infections
have not been prove, through culture ) given Nalidixid acid 55mg / kg / day given 4 doses of
ciprofloxacin for 10 days or 30 mg / kg / day divided into 2 doses for 5 days.
Zinc supplementation can be recommended as an option to reduce duration and severity
of diarrhea, to prevent the recurrence of diarrhea in the next 2-3 months. For a given nutrient diet
1000 kcal diet, 20 grams of protein to correct the nutritional status of patients.
The prognosis in these patients is dubia, the prognosis of diarrhea cases determined on
the severity of the disease, early diagnosis and appropriate treatment and sensitivity amoeba or
bacteria to the drugs. In the severe form, the high mortality rate unless they get early treatment.
But in moderate case, typically a low death rate; dysentriae form usually heavy and need long
healing period although in mild case. Flexneri has a low mortality rate. Some of the severe
complications duet of dysentery, especially when cause Shigella, include intestinal perforation,
toxic megacolon, rectal prolapse, convulsions (with) or without hiperpireksil, anemiaseptik,
hemolytic uremic syndrome and hyponatremia. The main complication of dysentery is losing
weight and nutritional status rapidly. It is caused by anorexia, nutritional needs of the body to
fight infection and repair intestinal damage and loss of protein through damaged tissue (eg, loss
of protein due to enteropathy). Death due to dysentery is usually caused by damage to the ileum
and colon, complications of sepsis, secondary infections (eg pneumonia) or malnutrition.
Children who are recovering from dysentery also increased the risk of death due to other
infections, caused by poor nutritional status or a decline in immunity.