Referat

Diarrhea in Children
Pembimbing: dr. Pulung M. Siahaan Sp.A

Oleh:
Annisafitria

Kepaniteraan Klinik Ilmu Kesehatan Anak

FKUIN-RS Bhayangkara TK.I Raden Said Sukanto
Jakarta 2017
 Definition

Loose stool or liquid stool with frequency,
generally> 3 times / day, or with estimated stool
volumes> 200 g / day or in infants and children>
10g/kg/day

Longo L, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Chapter 40: Diarrhea and
Constipation. Dalam: Harrisons Principles of Internal Medicine 18th Ed. Philadelphia: McGraw-Hill
Epidemiology

2000 301/1000 2003 374/1000 2006 423/1000 2010 411/1000

SKRT: Studi Mortalitas dan Riset

Kesehatan Dasar
Diarrhea is still a major cause
mortality in Indonesian because
of improper management, both
at home and in health facilities

Kementerian Kesehatan RI. Situasi Diare di Indonesia. Dalam: Buletin Jenedela Data dan
Informasi Kesehatan Triwulan II, 2011.
 Batasan
Acute diarrhea
< 2 weeks

Persistent diarrhea
2-4 weeks

Chronic diarrhea
> 4 weeks
Longo L, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Chapter 40: Diarrhea and
Constipation. Dalam: Harrisons Principles of Internal Medicine 18th Ed. Philadelphia: McGraw-Hill
 Acute diarrhea

Defecate 3 times per day with a change in the consistency of the stool
into a liquid with or without mucus and blood lasting less than a week

Babies with exclusive breastfeeding: Increasing the frequency of
defecation or consistency into a liquid that according to her mother is
abnormal or not as usual.

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-
Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
Mode of Transmission and Risk Factors

Finger
Not fully breastfeeding for the first 4 - 6
months
Lack of water hygiene
Field Flies Bad Personal hygiene
Preparation of food is not hygienic
Bad weaning

Fluid
Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-
Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Etiologi
Infection Food allergy Malabsorption

Anatomical Abnorm
Food poisioning drugs alities

Venita, Kadim M. Gastroenterologi Anak: Diare. Dalam: Kapita Selekta Kedokteran Edisi IV. 2014. Jakarta: Media Aesculapius.
 Infection

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar
Gastroenterologi-Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit
IDAI.
 Infection

Bhutta ZA. Chapter 340: Acute Gastroenteritis in Children. Dalam: Kliegman, Stanton, St Geme, Schor. Nelson Textbook of Pediatrics 20th Edition. 2016. Philadelphia: Elsevier
 Infection Pathogenesis
Non-Inflammatory
Enterotoxin of bactery
Destruction of villus surface by virus
Inflammatory
Adherence and/or translocation of bactery Direct invasion by bactery
Direct sitotoxin production by bactery, so
fluid, protein and cells (erythrocyte and
leukocyte) enters lumen

Bhutta ZA. Chapter 340: Acute Gastroenteritis in Children. Dalam: Kliegman, Stanton, St Geme, Schor. Nelson Textbook of Pediatrics 20th Edition. 2016. Philadelphia:
Elsevier
Persistent and chronic diarrhea

Diarrhea lasting 14 days.

Persistent usually ec infection
Chronic usually ec non-infection.

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-
Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Diagnosis
Anamnesis
Diarrhea description (frequency, onset, colour, consistency, with mucus/
blood)
vomitus Physical examination
Dehydration symptoms (thirsty, irritable, fatique, last defecation)
Fluid intake General condition
Fever Dehydration sign
convulsions
Signs of Acid Base imbalance and Electrolytes
Eating and drinking habit
People around Meteorismus ec hypokalemia
Treatment received
convulsions ec Na disturbance
Rapid breathing ec metabolic
acidosis
Venita, Kadim M. Gastroenterologi Anak: Diare. Dalam: Kapita Selekta Kedokteran Edisi IV. 2014. Jakarta: Media Aesculapius.
 Dehydration signs
Bhutta ZA. Chapter 340: Acute Gastroenteritis in Children. Dalam: Kliegman, Stanton, St Geme, Schor. Nelson Textbook of Pediatrics 20th Edition. 2016. Philadelphia:
Elsevier
 Additional examination

Stool examination not usual, except for lactosa intolerance and

suspicious of amebiasis
Severe dehydration serum electrolite, blood gas analysis, blood
glucose.
Sepsis and UTI darah lengkap, urine and stool culture, antibiotic
resistency.

Venita, Kadim M. Gastroenterologi Anak: Diare. Dalam: Kapita Selekta Kedokteran Edisi IV. 2014. Jakarta: Media Aesculapius.
Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-
Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
Bhutta ZA. Chapter 340: Acute Gastroenteritis in Children. Dalam: Kliegman, Stanton, St Geme, Schor. Nelson Textbook of Pediatrics 20th Edition. 2016. Philadelphia:
Elsevier
 Treatment

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Treatment
Oralit
1 sachet add 1 L boiled water (for 24 hour)
Give them / defecate
antibiotic
< 2 thn: 50 100 ml/ BAB Do not be given excpet there are indication ex
2 thn: 100 200 ml/ BAB cholera and dysentri.

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-
Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Treatment
ASI and other food
According the age of children with same menu.
Prevent to lose the body mass and replace the
Zinc
missing nutrien.
Function: growth and cell division, antioxidants,
cellular immunity, tasting, immunity, and appetite
10-14 days
Dosage
< 6 mo: 10 mg (1/2 tab)/ day
6 mo: 20 mg (1 tab)/ day

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi- Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Treatment

Education
control fever, bloody stool, recurrent, food intake, very thirsty,
frequent diarrhea, or didnt improved in 3 days.

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi- Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Treatment: :
TRO without Dehidrasi
Function: prevent Dehydration
Household fluids:
water tiller
Ammount 10 ml/ kgBB OR salt- sugar solution
< 1 yo vegetable sauce
50 100 ml
< 2 y.o (per 1 2 min)
1 5 yo
If vomit stop for 10 min and then start slowly
100 200 ml Do it until the diarrhea stops
5 12 yo

200 300 ml

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi- Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
 Treatment:
TRO mild to moderate Dehydration

Hospitalized
Give them oral therapy with oralit
oralit for first 3 hours
75 cc/ kgBB
If body mass is unknown
< 1 yo 300 ml
1 5 y.o 600 ml
> 5 y.o 1200 ml
Re-evaluate

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi- Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
Treatment:
TRP severe Give oralit simultaneously with liquid per-IV
Dehydration ( 5 ml/ kgBB/ hour) within 3 4 hours
(infant) or 1 2 hour (older children)
IV Line (RL 100 ml/ kgBB):
< 1 y.o: 30 cc/ kgBB (3 hours) 70 cc/ kgBB (5
hours)
1 y.o: 30 cc/ kgBB (1/2 hour) 70 cc/ kgBB (2
hours)
Evaluate per-hour
If not improved IV drip
6 hours (infant) or 3 hours (children)
evaluate advanced therapy

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi- Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.
Antibiotics

Juffrie M, Soenarto SS, Oswari H, Arief S, Rosalina I, Mulyari NS. Buku Ajar Gastroenterologi-
Hepatologi Jilid 1 Cetakan Kedua. 2010. Jakarta: Badan Penerbit IDAI.