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DIARRHOEA

VOLUME OF WATER
IN THE STOOLS

LOOSE WATERY
1
HYPERSECRETION

WATER
•MALDIGESTION
•HYPEROSMOLAR
MALABSORPTION •PERISTALSIS
•AREA FOR
ABSORPTION
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
BABIES FED ONLY BREAST MILK OFTEN
FREQUENT PASSING OF FORMED STOOLS
( 5-6 x / DAY )

THIS ALSO NOT DIARRHOEA


INFECTION - VIRAL
- FUNGAL
- BAKTERIA
- PARASITE

INFLAMMATION

DIARRHOEA NON INFECTION - ALLERGY


- etc

NONINFLAMMATION - HORMONAL
- ANATOMICAL
- etc
VIRAL DIARRHOEA

1. ROTAVIRUS  6 MONTHS TO 2.5 YEARS


2. NORWALK VIRUS
3. ENTERIC ADENOVIRUS
4. ASTROVIRUS
5. CALICI VIRUS
6. CORONA VIRUS
7. SMALL ROUND VIRUS
- PARVOVIRUS LIKE AGENT
- MINI ROTAVIRUS
- MINI REOVIRUS

6
PRACTICALY

-LIQUID STOOLS ≥ 3 X/ DAY


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

7
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 )
8
1.AGE
-NEONATAL DIARRHOEA
-INFANTILE DIARRHOEA
-CHILDHOOD DIARRHOEA

2. ONSET
-ACUTE DIARRHOEA : < 7 DAYS (90-95%)
-PROLONGED DIARRHOEA: 7-14 DAYS
-CHRONIC DIARRHOEA : > 14 DAYS

3. ETIOLOGY
-INFLAMMATION : INFECTION/NON INFECTION
-NON INFLAMMATION
9
4. SEVERITY( WHO, 1984)
-MILD DIARRHOEA : < 1x / 2 hours or < 5cc / KgBW /hours

-SEVEREDIARRHOEA: > 1x / 2 hours or > 5 cc/KgBW/hours

5.HOST DEFENCE

-IMMUNOCOMPETENT
-IMMUNOCOMPROMISED

6. SOURCE OF INFECTION

-NOSOCOMIAL
-COMMUNITY

10
7. PATHOGENESIS

ABSORPTIVE/ SECRETORY
OSMOTIC
1. FASTING STOPS CONTINUES
2. STOOL OSM. 400 280
3. Na + 30 100
4. K+ 30 40
5. (Na+K)x 2 120 280
6. SOLUTE GAP 280 0

11
8. EPIDEMIOLOGI
-ENDEMIC
-EPIDEMIC
-MIXED

9. SITE OF PATHOLOGY

-SMALL INTESTINE : CHOLERA, ETEC, ROTAVIRUS


AND G. LAMBLIA DIARRHOEA
-LARGE INTESTINE: SHIGELLOSIS, AMOEBIASIS
-BOTH : CAMPYLOBACTERIOSIS, SALMONELLOSIS

12
10. WHO (2005)

-ACUTE WATERY DIARRHOEA


-PERSISTENT DIARRHOEA
-DYSENTERY DIARRHOEA
-DIARRHOEA WITH SEVERE MALNUTRITION

13
MIKROORGANISMS

GASTRIC ACID

MULTIPLICATION

COLONIZATION
ADHERENT

ENTEROTOXIN - INVASION
- DAMAGE

HYPERSECRETION MALABSORPTION
HYPERPERISTALIS

COLONIC SALVAGE DIARRHOEA

PATHOGENESIS OF ACUTE INFECTIOUS DIARRHOEA


14
DIARE

Cleasing effect Loss of


• Pathogens • Water and Electrolytes
• Nutrients

Defense • Dehydration
• Hypoglicemia
Starvation
Malnutrition
Self Limited

 Water and Electrolytes


 Diets
15
WATER DEHYDRATION

ELEKTROLIT
ELECTROLYTES Na+ ==>
Na+ atau atau
 
K+ ==> 
K+
D Ca2+ ==>
Ca2+ ==> TETANY
Mg2+ ==>
Mg2+ ==> TETANY
I Zn ==>
Zn ==>ACRODERMATITIS
ACRODERMATITIS ENTEROPATHICA
ENTEROPATHICA
A
R BASE METABOLIC ACIDOSIS
R
H NUTRIENTS - HYPOGLYCEMIA
O - STARVATION
E - PCM
A
MUCOSAL - MALABSORPTION
INJURY - PROTEIN LOSING ENTEROPATHY.
- SENSITIZATION
- NEC
16
HYPOCALCEMIC

TETANY HYPOMAGNESEMIC

ALKALOTIC
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
SIGNS OF DEHYDRATION

1. LETHARGICS TO 7. HYPOTENSION
COMATOSE 8. WEAKNESS OF
2. SHUNKEN RADIAL PULSE
ANTERIOR 9. OLIGURIA/ANURIA
FONTANELLA 10.TURGOR
3. SHUNKEN EYES 11. COOL MOIST
4. ABSENT OF EXTREMITES
TEARS 12. BW
5. DRY OF MOUTH
AND TONGUE
6. TACHYCARDIA 19
DEHYDRATION

VOLUME PLASMA SODIUM

-SOME DEHYDRATION • ISONATREMIA


= 5 - 10 % BB = 135 - 150 mEq/L
-SEVERE DEHYDRATION
= > 10% BB • HYPO/HYPER
NATREMIA
THE OBJECTIVE OF TREATMENT ACUTE DIARRHOEA

DEHYDRATION PROTEIN CALORI DURATION,


MALNUTRITION SEVERITY,
EPISODES
PREVENTION TREATMENT

WATER & ELECTROLYTES FEEDING ZINC


21
A NEW EPISODE OF DIARRHOEA

DIARRHOEA OCCUR AFTER TWO FULL DAYS


WITHOUT DIARRHOEA

22
MANAGEMENT

ASSESSMENT TREATMENT

1. Degree of 1. Water & elektrolytes


Dehydration 2. Diets
2. Associated : 3. Drugs
• Malnutrition - Zinc
• Pneumonia - anti microbial
• etc - Symptomatic
- antidiarrhoeal 23
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
FLUIDS TREATMENT

REHYDRATION MAINTENANCE

INITIAL REPLETION NORMAL + ABNORMAL

HOLLIDAY – CHOLERA
SEGAR COT

25
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

NB : 100 mL  2,5 mEq Na+


 2 mEq K+
 100 calori
REHYDRATION

ORAL I.V.

ORS* • RINGER’S LACTAT


( ORALIT@) • RINGER’S ACETATE

* Oral Rehydration Salts


27
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

28
• CHO
• Peptide Na+ LUMEN
• Amino Acid water

Na+
2K+ ENTEROCYTES

3Na+ BASEMENT
MEMBRANE

BLOOD VESSELS
LAMINA
PROPRIA

29
MECHANISM OF ACTION ORS
ORAL REHYDRATION SALTS (WHO)

PREVIOUS NEW
(mmol/L) (mmol/L)

Na 90 75
K 20 20
Cl 80 65
Citrat 10 10
Glukose 111 75
311 245

30
NEW (LOW OSMOLARITY) WHO ORAL
REHYDRATION SALTS

• STOOL OUTPUT  = 20%


• VOMITING  = 30%
• THE NEED FOR SUPPLEMENTAL I.V FLUID
 = 33%
BOWEL LUMEN BLOOD VESSELS
ORS SOLUTION
SUGAR SOLUTION
SALT SOLUTION

DIARRHOEA
RESOMAL(REHYDRATION SOLUTION FOR MALNUTRITION

=Dissolve 1 “new ORS “ packed into 2 L of clean water


=Add 45 mL of KCl solution ( from stock solution containing
100 g KCl/L)
=Add and dissolve50 g sucrose

Na= 37,5 mEq/L


K=40 mEq/L
Sugar= 25 g/L

33
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
34
DEHYDRATION

NO SIGN OF SOME SEVERE

< 5% 5 - 10% > 10%

A B C
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


36
B. SOME DEHYDRATION

ORALIT  75 mL/kg BW /3 a 4 hours

INDICATION

• Ringer’s Lactate
• Ringer’s Acetate
37
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

38
ORALIT

• PREVENTION
• TREATMENT
• MAINTENANCE

DEHYDRATION DIARRHOEA
39
DIARHOEA

REHYDRATION

ANURIA/OLIGURIA ADEQUATE
URINE *

RENAL PHYSIOLOGIC NO PROBLEM


FAILURE OLIGURIA

FLUIDS  FLUIDS 
NB : 1. * 1 cc / kg BB / jam
40
2. Oliguria : < 400 cc / m2 / hari
Renal Physiologic
Failure Oliguria
Lasix diuresis (-) diuresis (+)

Laboratorium
 Urine osmolality <350 >500
(mOsm/kgH2O)
 Na+ urin (mEq/l) > 40 <20
 Fr. excr of Na+ >1% <1%

Fractional Na  urin/Na  plasma


excretion   100 %
of Na+ Cr. urin/Cr. plasma 41
FEEDING

AFTER REHYDRATION

NO RETURN OR WORSENING
OF DIARRHOEA

TOLERANCE TEST

● BREASTMILK
● SUB BAGIAN GE BIKA FKUSU: FORMULA MILK STOPPED
● ≥ 4-6 MONTHS OF AGE : BREAST MILK + OTHER FOODS
● PROBLEM: < 4 MONTHS OF AGE WHO ARE NOT
BREASTFED
● MTBS : FORMULA MILK(-)
● WHO ( 2005 ) : FORMULA MILK CONTINUED
42
43
BUKU MANAJEMEN TERPADU BALITA SAKIT (MTBS) WHO
ANTIMICROBIAL

Acute Diarrhoea
(WHO)

1. Cholera
2. Shigellosis
3. Amoebiasis
4. Giardiasis
44
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

45
SIDE EFFECT OF ANTIMICROBIAL

1. CHANGING OF INTESTINAL FLORA


2. OVERGROWTH:
- MONILIA
- ENTEROCOCCUS
- ANAEROB
- PSEUDOMONAS
3. MUCOSAL INJURY
4. IRRITATION
5. PSEUDOMEMBRANOUS ENTEROCOLITIS
6. BLOOD DYSCRASIA
7. VOMITING
46
ANTIDIARRHOEAL
(United States F.D.A)

A drug that can be shown by objective


measurement to treat or control the symptoms
of diarrhea

1. Bowel Movement
2. Stool Consistency
3. Cramps
47
Antidiarrheal
1.UNABSORBED 3. ADSORBENT :
ANTIMICROBIAL : -Kaolin/pektin
-Streptomycin -Charcoal
-Neomysin -Atapulgit / smectite
-Hydroxyquinoline
-Unabsorbed Sulfa 4. ANTISECROTORY:
- Salicylate Acid
2. ANTIMOTILITY : - Chlorpromazine
-- Loperamide
-- Diphenoxylate 5. TRIAL :
-Lactobacillus
-Fructooligosaccharide

NB : Gol 1 s/d 4  NO RECOMMENDED


48
KAOLIN
1. Stimulate viral-tissue penetration
2. No benefit in improving stools consistency
3. Suppress the effect of antibiotics
4. Cosmetic effect
5. Malabsorption

IODOHIDROXY QUINOLINE

1. No benefit
2. In Japan  Subacute Myelo Optic Neuropathy
OPIATES & SPASMOLYTICA

1. INCREASE DURATION OF FEVER


2. PROLONG PASSAGE OF PATHOGENS
3. DECREASE OF BOWEL PEWRISTALSIS
4. INCREASE THE DURATION OF
PROLIFERATION,TOXIN PRODUCTION
AND INVASIVE BY MICROORGANISMS
5. GUT PARALYSIS

50
DIARRHOEA

DEHYDRATION COMPLICATION

REHYDRATION - ELECTROLYTES
IMBALANCE
-RINGER’S LACTATE - METABOLIC ACIDOSIS
-RINGER’S ACETATE - FEVER
-ORS - CONVULTION
- HYPOGLICEMIA
ELECTROLYTES - ACID BASE

INITIAL REHYDRATION

DIAGNOSIS TREATMENT
ELECTROLYTES – ACID BASE

INITIAL REHYDRATION

ISONATREMIA HYPONATREMIA
DEHYDRATION

DILUTIONAL
DIARRHOEA

METABOLIC ACIDOSIS

ANION GAP

NORMAL INCREASED

• STARVATION
LOSS OF HCO3-
• RENAL
HYPOPERFUSION
• TISSUE HYPOXIA
• SALICYLATE
INTOXICATION
• INBORN ERROR 54
ANION GAP = Na+ - (Cl + HCO3-)

NORMAL = 8 – 16 mEq/L

55
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
DEHYDRATION + METABOLIC ACIDOSIS

REHYDRATION

pH , HCO3- , pCO2

pCO2 (calculated) = (1.54 X HCO3-) + 8.36 + 1.11

APPOPRIATE NO APPROPRIATE

METABOLIC ACIDOSIS

pH < 7.2 ATAU HCO3- < 10 mEq/L


- LUNG DYSFUNCTION (-)
- HYPOKALEMIA (-)
HCO3- = 1-2 mEq/Kg BB 57
NO APPROPRIATE

pCO2 (c) > pCO2 (lab) pCO2 (c) < pCO2 (lab)

METABOLIC ACIDOSIS METABOLIC ACIDOSIS


+ +
RESPIRATORY ALKALOSIS RESPIRATORY ACIDOSIS

HCO3-

OVERSHOOT METABOLIC ALKALOSIS PARADOXAL ACIDOSIS

58
DOSAGE OF HCO3- ( mg)

HCO3- = (HCO3- desired - HCO3- actual) X 0,3 X BB(kg)

HCO3- d ?
HCO3- d
= 20
H2CO3

HCO3- d = 20 x 0,03 pCO2 = 0,6 pCO2 ……..(1)

pCO2 ( 1,54 X HCO3-a ) + 8,36 ± 1,11 ……(2)


=
pCO2 - 8,36
HCO3-a = ± (O.6 pCO2 - 5)
1,54
HCO3- = 0,6 pCO2 - ( 0,6 pCO2 - 5) X 0,3 BB(KG)
= ± 1,5 m g/kgBB
= 1 - 2 m g/kgBB 59
BICARBONATE

1.SLOW INFUSION  TO PREVENT :


=OVERSHOOT METABOLIC ALKALOSIS
=ACIDOSIS INTRACELLULER
2.HYPOKALEMIARESPIRATORY PARALYSIS
3.LUNG DYSFUNTION PARADOXAL ACIDOSIS
4.CIRCULATORY INSUFFICIENCY
NaHCO3
I.V. ADMINISTRATION
CORRECTION OF
ACIDOSIS

SERUM : HCO3- + H + H2O + CO2


DECREASING
RESPIRATORY
DRIVE

BLOOD BRAIN BARRIER

CEREBRAL ACIDOSIS
AND DEPRESSION
SLOW RAPID
BRAIN : HCO3- + H+ H2O + CO2
MECHANISM OF PARADOXAL ACIDOSIS 61
vasodilatation ⇒ ICP↗↗

Hypercarbia acidosis intracelluler

anoxia

62
BICARBONAT

1 mEq/kgBB/X

DILUTES : 5-6 X 1 HOUR

TO PREVENT

INTRACRANIAL • OVERSHOOT
BLOOD VESSEL METAB.ALKALOSIS
RUPTURE • ACIDOSIS
INTRACELLULARE
63
DEHYDRATION + HYPERNATREMIA

REHYDRATION

HYPERNATREMIA
( > 150 mEq/l)

- IVFD STOPPED
- PLAIN WATER
DEHYDRATION + HYPONATREMIA

REHYDRATION

HYPONATREMIA
( < 135 mEq/L)

Asympt Sympt After


HypoNa HypoNa Rehydration

RL NaCl 3% Fluid Restriction

Na+(mEq) = (135 – Na+ plasma) x 0,6 x BW (kg)


DEHYDRATION HYPO/ HYPERKALEMIA

REHYDRATION
HYPOKALEMIA HYPERKALEMIA

Renal Function
Diarrhoea (+) Diarrhoea
Acute Renal Failure
RL ECG

Fluids
N abN
Restriction

K+ oral K+ drip
(upto 3 mEq / kgBW / day)
FEVER

TEMPERATURE DOWN

COOLING DRUGS

- Unclothed 1. Paracetamol :
- Wipe of sweat 30 mg/Kg/day - 3 doses
- Fanning 2. - Acetyl Salicylic Acid
- Tepid sponging - Mefenamic Acid

No recommended
CONVULSION

Diazepam: 1 mg/Kg/day
3 - 4 doses iv/per rectal

Hypoglicemia (<50 mg%)

Coma

Dextr. 10% IV  5 mL /Kg BW


within 5 minutes

Alert
V. CHOLERAE

O1 Non O1
(Non Agglutinable)
- Biotip - Eltor
- Classic

- Serotip - Ogawa
- Inaba
- Hikojima O2 - 138 O139
O140 - 142

“Bengal Strain”
69
ENTEROTOXIN

Absorption of Na+ Surface Receptor


in Villous Cells are intact

Adenyl Cyclase

C - AMP

Secretion of Cl-
in Crypt Cells
Absorption

Bowel Lumen
Villi

Secretion

Crypt
V. CHOLERAE

JEJUNUM

- COPIOUS DIARRHOEA
- FISHY RICE WATER STOOLS
- FEVER (-)
- ABDOMINAL PAIN (-)
- RAPID DEHYDRATION & SHOCK

- BIOCHEMICAL (+)
- HISTOLOGY (-)
DIAGNOSIS

CHILDREN > 2 YEARS


- CLINIC
SEVERE DEHYDRATION

THE OTHER CHILDREN (+)

DARK FIELD MICROSCOPE


- LAB
CULTURE
Th Water & Electrolytes  Ringer’s
Lactate I.V.

Rehydration & Maintenance

Fecal Sodium
( 88 – 101 mEq/ L)

FEEDING

ANTIMICROBIAL  Tetracycline or
Doxycycline
DYSENTERY SINDROME = BLOODY DIARRHOEA

1. DYSENTERY
- BACILLARY
- AMOEBIC

2. Enterocolitis
- Cows milk allergy

3. Trichuriasis

4. Others - Entero invasive E coli


- C. jejuni
BACILLARY DYSENTERY
= SHIGELLOSIS

S. DYSENTERIAE
S. FLEXNERI
S. BOYDII
S. SONNEI

COLON
SHIGELLA

INVASIVE SHIGA TOXIN

INHIBITION OF
PROTEIN SYNTHESIS

CYTOTOXIC
SHIGELLA

- WATERY DIARRHOEA - FEVER


- BLOODY DIARRHOEA - CONVULSION
- TENESMUS - SEPTIC
- ABDOMINAL PAIN - HEMOLYTIC UREMIC
- URGENCY SYNDROME
- TOXIC MEGA COLON
- RECTAL PROLAPS
Th
1. WATER & ELECTROLYTES

2. FEEDING

3. - SELF LIMITED
- SEVERE • TMP - SMX
• Cefixime:
8 mg/kg/day
2 doses
• nalidixic acid
• ampisilin
SALMONELLOSIS

• TYPHOIDAL ENTERIC FEVER :


-S. TYPHOID TYPHOID FEVER
-S. PARATYPHOID PARATYPHOID FEVER

• NON TYPHOIDAL : SALMONELLA


GASTROENTERITIS

80
INDICATION OF ANTIMICROBIAL
TREATMENT IN SALMONELLA
GASTROENTERITIS

1.  3 MONTHS OF AGE
2. OLD DEBILITATED PATIENT
3. DYSENTERY FORM ESPECIALLY
ILLNESS > 5 DAYS
4. IMMUNOCOMPROMISED : STEROID,
MALIGNANCY
5. BACTERIAEMIA
ACUTE DIARRHOEA PERSISTENT DIARRHOEA

PROLONGED MUCOSAL INJURY

=MALNUTRITION
=IRON DEFICIENCY
=ANTIBIOTICS
=COW’S MILK
=INFECTION
82
MALABSORPTION OF NUTRIENT
PEM
BACTERIAL OVERGROWTH
AND INFECTION

PROLONGED MUCOSAL INJURY

DECREASED
INEFFECTIVE VILLOUS REPAIR
ENTERIC HORMONE

INCREASED ABSORPTION OF
NATIVE FOREIGN PROTEIN
83
DEGREE OF DEHYDRATION

DEFISIT OF BW CLINIS (WHO,2005)

84
GOLD STANDART DEGREE F
DEHYDRATION

BW PREILLNESS( X )- BW DURING ILNESS ( Y )

X-Y
x 1OO %
X

85
A. X= 10 Kg 10-9,25
x 100 %= 7,5 %
Y= 9,25 Kg 10 (Some dehydration)
Fluid defisit= 10-9,25=0,75 Kg=750 cc

B. Some dehydration= 7,5 % X ?


BW on admission(Y)=9,25 Kg
(X-Y)100=7,5 X92,5 X=100YX=100/92,5 X 9,25
=10 Kg
Fluid defisit=10-9,25 = 750 cc
C. Fact 75 cc/Kg=75 x 9,25= 694 cc
86