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DIARRHEA IN CHILDREN
ANDHIKA HADI WIRAWAN 1102010020
Faculty of Medicine Yarsi
Pediatric Department
INTRODUCTION
DIARRHEA
The diarrhea word came from the Diarola
from Yunaani which means flowing through.
Indonesia :
About 30% bed in hospital filled by baby and
chlidren with diarrhea
In primary healthcare, diarrhea on the second
place in top 10 disease with most population
ACUTE DIARRHEA
Definition
EPIDEMIOLOGY
Leading Cause:
Viral
: Rotavirus
Bacteria : Campylobacter and Salmonella (depending
which country)
Indonesia :
Leading cause of death in chlidren < 5 years old
Based on Risdeskas 2007 :
Number 1 leading cause of death in baby (42 %, more than
pneumonia : 24%)
Number 1 leading cause of death in 1-4 years old (25,2%,
more than pneumonia : 15,5%)
ETIOLOGY
Baktery :
Aeromonas
Bacillus cereus
Campylobacter jejuni
Clostiridium perfringens
Clostiridium defficile
Escherichia coli
Plesiomonas shigeloides
Salmonella
Shigella
Staphylococcus aureus
Vibrio cholera
Vibrio parahaemolyticus
Yersinia enterocolitica
Virus :
Astovirus
Calcivirus (Norovirus, Sapovirus)
Enteric adenovirus
Coronavirus
Rotavirus
Norwalk virus
Herpes simplex virus*
Cytomegalovirus*
Parasite :
Balantidium coli
Blastocystis homonis
Cryptosporidium parvum
Entamoeba histolytica
Giardia lamblia
Isospora belli
Strongyloides stercoralis
Trichuris trichuria
MECHANISM
Osmotic diarrhea
Secretoric diarrhea
General malabsorbtion
Peristaltic disorder
Immunology related
OSMOTIC DIARRHEA
PERISTALTIC DISORDER
GENERAL MALABSORBTION
Atrophy villi.
Certain
microorganisms
causes
nutrient
malabsorbtion by changing pyhysiology of brush
border without change in anatomy
The
complete carbohydrate maldigestion, and
trigliserid caused by insufficient pancreas ecsocrin
that causes significant malabsorbtion and osmotic
diarrhea
IMMUNOLOGY RELATED
Reaction to an allergen immunity which resulted
in the release of various cytokines that can lead
to tissue damage the intestinal mucosa
Damage can be in the form of atrophy of
intestines villi thus causing malabsorption
SECRETORIC DIARRHEA
Hiperplasia kripta
The theoretical existence of hyperplasia due to any
disease, kripta can cause intestinal secretion and
diarrhea. This disease generally caused villus
atrophy.
Luminal secretagogues
2 ingredients :
1.Enterotoxin of bacteria
2.Chemicals (Laxative)
ENTEROTOXIN
CHEMICALS (LAXATIVE)
DIAGNOSIS
Anamnesis
Duration, frequency, volume, consistency, colour,
smell, mucous? Blood?
+ vomitting : volume dan frequency.
Diuresis: normal, decrease, in last 6-8 hours.
Food and drink consumption during diarrhea
Sufferring other disease?(cough,influenza, otitis,
measles)
Medicine given
Immunization history
Healthy
Restless,
delirious, coma,
Condition
crying, apatis,
shcok
Skin
sleepy
Slightly
Extremely decreased
examined
General
Normal
decreased
elasticity
Eyes
Anterior
Normal
Slightly
Extremely sunken
Normal
sunken
Slightly
Slightly sunken
sunken
fontsnelle
Mouth
Normal
Dry
Dry&Cyanosis
Radial
Strong< 120
Moderate(120
Weak> 140
Normal
1
Thirsty, restless
or lethargic but
irritable when
2
Drowsy, limp, cold or sweaty
comatose
touched
Extremely sunken
Eye
Mucous Membranes
(Tongue)
Normal
Slightly sunken
Moist
Sticky
LABORATORY
Blood: complete blood, serum elektrolit, AGD,
glucose, culture and antibiotic sensitivity test
Urine: complete urine, culture and antibiotic
sensitivity test
Feses: macroscopic dan microscopic
TREATMENT
1.
2.
3.
4.
5.
1.ORALIT
Give mother 2 sachet oralit
Mix 1 sachet oralit with 1 liter boiled water, for
24 hours stock.
Give oralit everytime children defecate:
Children <2 years old : give 50-100 ml after
defecate
Children 2 years old
: give 100-200 ml after
defecate
If in 24 hours still there is oralit left, dispose
Mmol/liter
Natrium
75
Klorida
65
Glucose, anhydrous
75
Kalium
20
Sitrat
10
Total osmolarity
245
2.ZINC
Zinc dosage for children
<6 months
: 10mg ( tablet) per day
>6 months
: 20 mg (1 tablet) per day
3. CONTINUE BREASTFEEDING AND FOOD
Based on childrens age with same menu during
healthy, to prevent loss of body weight and change
loss of nutrition
4. SELECTIVE ANTIBIOTIC
Dont Give antibiotic unless there is an indication,
for example bloody diarrhea or cholera.
Selective antibiotic :
Cholera : Tetracycline 12.5 mg/ kg/ 24 hours or
Erytromycin 12.5 mg/kg. Four times per day,
given for three days
Shigella Dysentri : Ciprofloxacin 25mg/ kg /24
hours or Ceftriaxone 25mg/kg. Two times per
day.given for three days
Amoeba : Metronidazole 15 mg/ kg/ 24 jam, Three
times per day.given for five days
SEVERE DEHYDRATION
Childs
Weight
1-10 kg
100 ml/kg
10-20 kg
>20 kg
COMPLICATION
SEIZURE
ELECTROLIT IMBALANCE
HIPERNATREMI
HIPONATREMI
HIPERKALEMI
HIPOKALEMI
PREVENTION
AGENT
Breastfeeding
properly
Make a habit of washing hand with soap after
defecate and before eat
Use clean toilet for all family member
HOST
Breastfeeding until 2 years
Nutrition
Immunisation
PROBIOTIC AND PREBIOTIC