DIARE AKUT PADA ANAK

2
3
4
• Increase frequency watery
stools more than 3 times per
day
• Relative to the usual habits of
each individual

5
Etiology of Diarrhea
Non
Infective infective

Viruses Allergic
Symptomatic
Bacteria
Inappropriate feeding Food
Parasites intolerance
Fungi Climate
7
8
9
• History
• Signs of Dehydration
• Other disease
• Skill

10
Signs & Sympt. Mild Moderate Severe
General Thirsty, Thirsty, irritable, Dowsy – limp,
allert,restless Or drowsy skin cold/sweaty

Radial pulse Normal rate Rapid and weak Rapid, feeble

Respiration Normal Deep Deep and rapid
Anterior font Normal Sunken Very sunken
Skin turgor Pinch retracts Retracts slowly Poor
immediately
Eyes Normal Sunken Grossly sunken
Tears Present Absent Absent
Mucous memb. Moist Dry Very dry
Urine flow Normal Dark & decreased Oliguria/anuria
 Pediatric Standard Therapy of Soetomo Hospital 2008

Pediatric Fluid Rehydration (iso-hyponatremia)

Degree of Estimation of Type of Route of treatment

Plan fluid solution
dehydration

A Normovolemia 10-20 ORS oral

ml/kg/diarrhea

B Moderate 6-9% 70ml/kg/3h HSD/ORS Iv/intra gastric

Mild 50ml/kg/3h HSD/ORS Oral/iv/intragastri

c

C Severe 30ml/kg/1h Ringer iv

Lactate

Bronchopnemonia, Severe Malnutrition; Neo/<3 Mo : D10%0,18 NaCl :

severe : 30ml/kg/2h ; Mild :70ml/kg/6h
Hypernatremia : HSD 320ml/kh/48h
• Replacement water and electrolyte
• Maintenance
• Replacement on going abnormal losses
• Individual

14
15
 Do not use the IV route for rehydration
except in cases of shock
 ReSoMal 5ml/kg/30 minutes for first 2
hrs ; then 5-10 ml/kg/h for the next 4-10
hrs
 ReSoMal : 37.5mmol Na, 40mmol K and
3 mmol Mg per litre
• NaCl 2.6 g • Na+75 mEq/l
• Na Citrate 2.9 g • K+ 20 mEq/l
• KCl 1.5 g • Citrate 10 mmol/l
• Glucose 13.5 g • Cl- 65 mEq/l
• Glucose 75 mmol/l

• Osmolar. 245 mmol/l

• Stool output is reduced by 25 to 30%

• Vomiting is reduced by 30%, and

• The need for unscheduled IV fluids is reduced by more

than 35%
 Low
Low

Inter-
Inter-
mediate
mediate

High
High

~33% of the world’s population

live in countries with a high risk
of zinc deficiency
• 20% reduction in duration of acute
diarrhoea
• Significant reduction in diarrhoea severity
• 24% reduction in duration of persistent
diarrhoea
• 42% reduction in treatment failure or death
in persistent diarrhoea
• Zinc supplementation for 10-14 has longer term effects on
childhood illnesses in the 2-3 months after treatment
• 34% reduction in prevalence of diarrhoea
• 26% reduction in incidence of pneumonia
• Zinc Dose : < 6 Mo (10mg) for 10 days
• > 6 Mo (20 mg)

• Zinc Investigators’ Collaborative Group. Pediatrics. 1999.

• "Booster" effect on immune function: Zinc is the main-
cofactor of immune function enzymes

• Anti-Secretory effect: Zinc acts as a K channel blocker

of cAMP mediated chlorine secretion, leading to
increased absorption of Na+ et reduced secretion of Cl

• Anti-oxydative effect: maintenance of tissue integrity

• Statistically significant effect on Antibiotic ass.
Diarrhoea 0.48 (95% CI 0.35 – 0.65)
• But no statistically significant effect on:
• Traveller's diarrhoea 0.92 (95% CI 0.79 – 1.06)
• Community-based diarrhoea
• 0.95 (95% CI 0.87 – 1.04)
Probiotics may be efficacious in preventing antibiotic
associated diarrhoea, however

There is not enough evidence from community-based

studies, and from developing countries to make any
global recommendation for use of probiotics in the
management of diarrhoea
• Given orally when vomiting
stops.
• Tetracycline is the standard
treatment
• Administered in single dose
primarily to prevent spread
of secondary infection

WHO guidelines
• Treatment of dehydration with ORS solution (or with an intravenous
electrolyte solution in cases of severe dehydration)
• Provide children with 20mg per day of zinc for 10-14 days
• Continue feeding or increase breastfeeding during, and increase feeding
after the diarrhoeal episode
• Use antibiotics only when appropriate (i.e. bloody diarrhoea and cholera)
and abstain from administering anti-diarrhoeal drugs (including
probiotics)
• Advise mothers on danger signs and on compliance with the treatments

WHO/UNICEF. Joint statement on the clinical management of acute diarrhoea.

2004.
New Recommendations on the
Management of Diarrhoea
– “Fecal–oral” via Food
– Water
– Hands
• Low infectious dose(e.g., shigella, giardia, rotavirus,
cryptosporidium) can be transmitted by person-to-
person contact

• High infectious dose(e.g., salmonella, E. coli,vibrios)

usually transmitted by water or food
• Breastfeeding and complementary feeding
• Improving food safety, water, sanitation, and hygiene
• Vitamin A
• Zinc
• Measles immunization
• Future—specific vaccines, e.g., for rotavirus, ETEC
(enterotoxigenic Escherichia coli), shigella
• Suboptimal breastfeeding
• Contaminated complementary foods
• Poor quality of water
• Poor sanitation and hygiene
• Malnutrition and micronutrient deficiencies
- vitamin A deficiency
- zinc deficiency
• Breastfeeding
• Safe complementary feeding
• Latrines and hand washing
• Water supply and quality
• Correcting Vitamin A deficiency—reduces mortality, but
not incidence
• Correcting zinc deficiency—reduces mortality and
incidence
• Preventing stunting—reduces mortality and incidence