ACUTE DIARRHEA

PRECEPTOR :
dr. Ulynar Marpaung, Sp.A

BY :
SARAH FAJRIAH
1102011254

Clerkship of Pediatrics Department

Faculty of Medicine YARSI University
Police Hospital, Bhayangkara Tk.I Raden Said Sukanto
 IDENTITY
Name : Child P
Birth Date : Oct 30th, 2014
Age : 22 months
Gender : Male
Address : Kp. Makasar cililitan
Nationality : Indonesian
Religion : Moslem
MR No. : 8278**
Date of admission : August 20 th, 2016
Date of examination : August 25th, 2016
 Parents identity
Father Mother

Name Mr. M Mrs. M

Age 40 years old 38 years old

Job Private employees Housewife

Nationality Indonesian Indonesian

Religion Moslem Moslem

Education High school High school

Earning/month Rp 3.000.000,- -

Address Kampung makassar Cililitan

 ANAMNESIS

The anamnesis was taken on August 21th 2016 using

alloanamnesis method. It was taken at room No. 5 Anggrek 2
Ward, RS Bhayangkara tk.I R. Said Sukanto, Jakarta.

Main complaint : Fever since 2 days prior to

admission to hospital

Additional complaint :
Watery stools ≥ 10x/day since 3 days before admission
to hospital, dregs (+), foam (+), acid odor, blood (-),
mucous (+), the color is yellow. Vomiting after drinking
and eating, frequency ≥5x/day.
• A 22 months old boy • His mother also
complained that her
with body weight 11,5 2 days ago son got diarrhea
kg came to RS since 2 days ago
Bhayangkara tk.I R. Said after fever. • Other than that, the
Sukanto Emergency frequency ≥ patient stomach was
Room at August, 20th • the patient has gotten 10x/days, bloated, his mother
2016 on 5 am with a fever. The fever high consistency liquid, says the patient was
constantly and wasn’t with a little dregs, vomiting, frequency
main complaint of fever foam positive, no
since 2 days ago. measured. His mother blood, acid odor, ≥5x every after
gave sanmol syrup to the colour is yellow. drinking dan eating,
decrease the yellow liquid.
temperature but it did 2 days ago
not go down well. (after fever)
HISTORY OF
ILLNESS
History of Past Illness
Pharyngitis/Tonsilitis -
Bronchitis -
Pneumonia -
Morbilli -
Varicella -
Diphteria -
Malaria -
Polio -
Enteritis -
Bacillary Dysentry -
Amoeba Dysentry -
Diarrhea -
Thypoid -
Worms -
Surgery -
Brain Concussion -
Fracture -
Drug Reaction -
Febril seizure -
 Allergic History Child’s Birth History

• The patient didn’t • Labor : Hospital

• Birth attendants: Doctor
have allergy to • Mode of delivery: Normal
medicine • Gestation : 38 weeks
• The patient didn’t • Infant state : Healthy
have allergy to food • Birth weight : 3500
grams
• The patient didn’t • Body length : 51 cm
have allergy to
weather and pollen
DEVELOPMENT
HISTORY

Raised hand
Smile 1months
2 months

Conclution : growth and

developmental is still in the normal
limits and was appropriate
according to the patient’s age
Child’s Eating History
Breast milk : + until now
Formula milk :+
(chilkid)
Baby biscuits :+
(milna, sun)
Fruit and vegetables :+
Solid food and side dishes
:-
IMMUNIZATION
HISTORY
Immunization Frequency Time

BCG 1 time 2 month

Hepatitis B 2 time 0 month

DPT 4time 2,4,6 months

Polio 4 time 0,2,4,6 month

Campak - -
 FAMILY HISTORY

Family History There are not

Patient’s There areany notsignificant
any
illnessesoror
father is significant illnesses
chronic
healthy chronic illnesses in the
illnesses
family declared in
Patient’s
the family
mother is
declared
healthy
 PHYSICAL EXAMINATION

Anthropometry Status
Weight : 11,5 kg
Height : 84 cm

Nutritional Status based on NCHS (National Center for Health

Statistics) year 2000 :
WFA (Weight for Age) : 11,5/12,3 x 100 % = 93 % (good
nutrition)
HFA (Height for Age) : 84/85.3 x 100 % = 98 % (good
noutrition)
WFH (Weight for Height) : 11,5/12,3 x 100 % = 93 % (good
noutrition)
 ANTHOPOMETRY
STATUS
Weight
: 11,5 kg
Height
: 84 cm

WFA (Weight for Age) : 11,5/12,3

x 100 % = 93 % (good nutrition)
HFA (Height for Age) : 84/85.3 x
100 % = 98 % (good noutrition)
WFH (Weight for Height) : 11,5/12,3
x 100 % = 93 % (good noutrition)

Conclution :
The patient has good noutritional status.
 Head to Toe
Examination
Head
Normocephal, hair (black, normal distribution, not
easily removed), sign of trauma (-), large fontanelle
closed, fontanel concave (+)
Eyes
Icteric sclera -/-, pale conjungtiva -/-, hyperaemia
conjungtiva -/-, Tears +/+ sunken eyes +/+, pupils
3mm/3mm isokor, direct and indirect light response
++/++.
Ears
Normal shape, no wound, no bleeding, secretion or
serumen.
Nose
Normal shape, midline septum, secretion -/-.
Mouth
Lips : dry
Teeth : lot ofcaries
Mucous : Watery
Tongue : clean
Tonsils : T1/T1, no hyperemia
Pharinx : no hyperemia
Neck
Lymph node enlargement (-), scrofuloderma (-).
Thorax
Inspection : Symmetric when breathing, retraction (-), ictus
cordis is not visible, rash (+)
Palpation : Fremitus tactile +/+ symmetric, mass (-)
Percussion : Sonor on both lungs
Auscultation : Cor : S1-S2 regular, murmur (-), gallop (-)
Pulmo : vesicular +/+, ronchy -/-, wheezing -/-
Abdomen
Inspection : Convex, epigastric retraction (-), spider nevi (-),
rash (-)
Palpation : Supple, abdominal mass (-), liver and spleen
not palpable, fluid wave (-)
Percussion : tympanic abdomen on the entire field, shifting
dullness (-), bloated (+), Auscultation : bowel sound increase,
bruit (-)
Vertebra
There weren’t appear scoliosis, kyphosis, lordosis, and any
massa long the vertebral line.
Ekstremities
Warm, capillary refill time <2 second, edema (-)
Skin
Turgor slowly, rash (-), dry skin (-)
Genitalia
Anus Hyperemis (+)
 MOTORIC EXAMINATION
Power
- Hand 5555/5555
NEUROGICAL - Feet 5555/5555
EXAMINATION Tonus
- Hand Normotonus / Normotonus
- Feet Normotonus / Normotonus
Trophy
Hand Normotrophy / Normotrophy
Meningeal -
- Feet Normotrophy / Normotrophy
Physiologic Reflex
Sign Upper extremities
- Biceps +/+
Nuchal rigidity (-)
- Triceps +/+
Kernig sign (-) Lower extremities
Lasegue sign (-) - Patella +/+
- Achilles +/+
Brudzinski I (-)
Pathologic Reflex
Brudzinski II (-) Upper extremities
- Hoffman -/-
- Trommer -/-
Lower extremities
- Babinsky -/-
- Chaddock -/-
- Oppenheim -/-
- Gordon -/-
- Schaeffer -/-
Clonus
 AUTONOM
EXAMINATION

Defecation Diarrhea (frequency 10

Urination times daily)
Sweating Normal (4-5 times daily)
Normal
 LABORATORY
INVESTIGATION

Hematology (August, 20th, 2016)

Hematology Results Normal Value

Hemoglobin 11,8 13 – 16 g/dl

Leukocytes 13.600 5.000 – 10.000 u/l

Hematocrits 34 40 – 48 %

Thrombocytes 265.000 150.000 – 400.000 /ul

Complete urin (August, 20th, 2016)
Results Normal Value
Color Yellow
Purity Clear
Ph 7.0 5 – 8.5
Specific
1.010 1.000 – 1.030
Weight
Protein - Negative
Bilirubin - Negative
Glukosa - Negative
Keton - Negative
Blood/ Hb - Negative
Nitrite - Negative
Urobilinogen 0,1 0,1 – 1,0 IU
Leucocytes - Negative
Sedimen :
*Leucocytes 1–2 0 – 5 /LPB
*Erythrocytes 0–2 1 – 3 /LPB
*Epitel Cell -
*Silinder - /LPK
*Crystal -
Others -
Complete feces (August, 20th 2016)
Results Normal Value
Macroscopic
Color Green
Consistency Liquid
Mucous +
Blood -
Microscopic
Leucocytes 0-1/LPB
Eritrocytes 2-3/LPB
Worm eggs
Ascaris Sp -
Anchilostoma Sp -
Trichuris Sp -
Oxyuris Sp -
Others -
 MANAGEMENT

IVFD Kaen 3B 1050 cc/ 24 hours (32 tpm)

Paracetamol 4x1cc per oral
Lacto B 3x1 sachet
Zinkkid syr 1x10mg
 PROGNOSIS
Quo ad vitam : dubia ad bonam
Quo ad functionam : dubia ad bonam
Quo ad sanactionam : dubia ad bonam
 Follow up
August, 21st 2016, second day of hospitalization, 4th day of illness

S Fever (+)
Defecation (+) frequency 8x, consistency liquid, green color, acid odor, foam(+) dregs (+)mucous
(-)blood (+)
Bloated (+)

O Consciousness : Compos Mentis

General condition : Midly ill
Temperature : 38,5°C
Pulse : 111 x/min
Respiratory rate : 2 x/min
Head : Normocephal, fontanel concave (+)
Eyes : Pale conjungtiva (-), icteric sklera (-), hyperemia
conjungtiva (-), sunken eyes +/+ tears +?+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemiapharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/-
Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin : dry (+)
Turgor : Slowly
Akral : Warm
Anus : Hyperemis (+)
 Laboratory Investigation
Kimia clinic (August,21st 2016)
Electrolite Results Normal Value

Natrium 133 135-145 mmol/l

Kalium 2,3 3,5-5,0 mmol/l

Chlorida 101 98-108 mmol/l

A Acute Diarrhea with mild-moderate dehydration

Hypokalemia
P IVFD KAEN 3B 1100 cc/24 hours
Paracetamol 3x1cc per oral
Inj. Cefotaxime 2x500mg
Lacto B 3x1 sachet
Zinkkid 1x10mg
KCL 10 mEq/ kolf
 Follow up
August, 22nd 2016, third day of hospitalization, 5thday of illness

S Fever (↑↓)
Defecation (+) frequency 5x, consistency liquid, yellow to green color, acid odor, foam(-) dregs (+)
mucous (+) blood (-)

O Consciousness : Compos Mentis

General condition : Midly ill
Temperature : 38 °C
Pulse : 110 x/min
Respiratory rate : 24 x/min
Head : Normocephal, fontanel concave (-)
Eyes : Pale conjungtiva (-), icteric sklera (-), hyperemia
conjungtiva (-) sunken eye +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/-
Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (-), bowel sound (+) increase, bloated (+),
abdominal pain (-)
Skin : dry (+)
Turgor : Slowly
Anus : Hyperemis (+)
Akral : Warm
Hematology (August, 22nd 2016)
Hematology Results Normal Value

Hemoglobin 9,1 13 – 16 g/dl

Leukocytes 12,400 5.000 – 10.000 u/l

Hematocrits 25 40 – 48 %

Thrombocytes 354.000 150.000 – 400.000 /ul

A Acute Diarrhea with mild-moderate

dehydration
Hypokalemia
P IVFD KAEN 3B 1100 cc/24 hours
Paracetamol 3x1cc per oral
Inj. Cefotaxime 2x500mg
Lacto B 3x1 sachet
Zinkkid 1x10mg
KCL 10 mEq/ kolf
 Follow up
August,23rd 2016, fourth day of hospitalization, 6th day of illness

S fever (-)
Defecation (+) frequency 2x, consistency liquid, yellow color, no odor, foam(-) dregs (+) no
mucous nor blood

O Consciousness : Composmentis
General condition : Midly ill
Temperature : 36,5 °C
Pulse : 110 x/min
Respiratory rate : 24 x/min
Head : Normocephal, fontanel concave (-)
Eyes : Pale conjungtiva (-), icteric sklera (-), hyperemia
conjungtiva (-) tears+/+
Mouth : dry lips, wet mucosa, tonsils T1/T1
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/-
Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (-), bowel sound (+) normal, bloated (-)
Turgor : Normal
Anus : Hyperemis (-)
Akral : warm
 Electrolite Results Normal Value
Natrium 134 135-145 mmol/l
Kalium 4,3 3,5-5,0 mmol/l
Chlorida 101 98-108 mmol/l

A Acute Diarrhea with mild-

moderate dehydration
P IVFD KAEN 3B 1100 cc/24
hours (AFF)
Paracetamol 3x1cc per oral
Lacto B 3x1 sachet
Zinkkid 1x10mg
Micozalf zalf
 Follow up
August, 25th2016, fifth day of hospitalization, 8st day of illness

S fever (-)
Defecation (+) frequency 2x, consistency liquid, yellow color, no odor, foam(-) dregs (+) no
mucous nor blood

O Consciousness : Composmentis
General condition : Midly ill
Temperature : 36,5 °C
Pulse : 110 x/min
Respiratory rate : 24 x/min
Head : Normocephal, fontanel concave (-)
Eyes : Pale conjungtiva (-), icteric sklera (-), hyperemia
conjungtiva (-) tears+/+
Mouth : dry lips, wet mucosa, tonsils T1/T1
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/-
Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (-), bowel sound (+) normal, bloated (-)
Turgor : Normal
Anus : Hyperemis (-)
Akral : warm
A Acute Diarrhea with
improvement

P IVFD KAEN 3B 1100 cc/24 hours (AFF)

Paracetamol 3x1cc per oral
Lacto B 3x1 sachet
Zinkkid 1x10mg
Micozalf zalf
 SECTION II
LITERATURE REVIEW
DEFINITION
Diarrhea is the passage of loose or watery
stools at least 3 times in a 24- hour period.
However, it is the consistency of the stools
rather than the number that is most
important. Acute diarrhea may be caused by
different viruses, bacteria, and parasites
 bacteria

viruses parasites

ETIOLOGY
EPIDEMIOLOGY
 CLINICAL
MANIFESTATION
Dehydration
Clinical manifestation of dehydration
DIAGNOSIS

Anamnesis
Frequency of urination,
should be asked the volume and frequency of
following matters: a long vomitting, food and drinks
diarrhea, frequency, volume, were given, Is there any heat
fecal consistency, color, odor, or other accompanying
presence or absence of diseases, other actions that
mucus and blood. have been carried out during
diarrhea.
Physical examination

Further need to find the main signs

of dehydration: awareness, thirst
On physical examination need to
and skin turgor abdomen and signs
be examined: weight, body
of other extras: fontanel concave or
temperature, heart rate and
not, the eyes: cowong or not, the
respiration and blood pressure.
presence or absence of tears, lips,
oral mucosa and tongue dry or wet.
 Detailed laboratory examination in acute
diarrhea is generally not required, only in
certain circumstances may be required,
for example the underlying cause is
unknown or there are other causes other
than acute diarrhea in patients with
severe dehydration.

Laboratorium
Microscopic examination for the
presence of leukocytes can provide
information about the cause of diarrhea,
anatomical location and the presence of
mucosal inflammation process.
THERAPY
Rehydrate
by using
the new
ORS

Zinc is
Advice to given for 10
parents consecutive
Ministry of
Health identified days
five pillars of the
management of
diarrhea

Breast milk
Antibiotics and food to
selective be
continued
 Recommendations for inpatient hospital based
on consensus and is followed by the following
conditions:

Neurological
Dehydration weight abnormalities Intractable, bilious
Shock
(> 9% weight) (lethargy, vomiting
convulsions)

Conditions for safe

Allegedly follow-up and
oral rehydration (-) Low intake
abnormality surgery management can not
be done at home
 CONCLUSSION
Diarrhea is the passage of loose or watery stools at least
3 times in a 24 hour period. However, it is the
consistency of the stools rather than the number that is
most important. Acute diarrhea may be caused by
different viruses, bacteria, and parasites. It is most
practical to base the treatment of diarrhea on the
clinical type of the illness, which is easy to establish
when a child is first examined.