LITERATURE

REVIEW
DIARRHEA
DEFINITION

Diarrhea is the reversal of normal

net absorptive status of water and
electrolyte absorption to secretion.

Acute diarrhea is defecation more

than 3 times per day, followed by
changes in the consistency of stool
become watery with or without
mucus and blood, that lasts less
than fourteen days.
 Epidemiology

WHO:
01 Globally 2 billion cases per year with 2.5 million
death cases per year

In 2010: 411/1.000 civilian

02 Indonesia Second highest cause of death in
children under five y/o

Incidence rate: 4.8%

03 South sumatra Period prevalence: 4.5%
Palembang has the most number of diarrhea cases:
16.033 children under five y/o
 Etiology
Infection Non-infection

caused by bacteria, virus, malabsorption, allergy,

poisoning, immunodeficien
or parasitic infestations cy, and other causes

Infection and poisoning are the most prevalent causes found in clinical setting.
In children under 5 years old, rotavirus is the most common agent.
 Pathophysiology
Exudative Diarrhea
Colitis, tumor

02

Osmotic Diarrhea 01 Secretory Diarrhea

03
Malabsorption, lactose intolerance Cholera
Pathophysiology of Diarrhea
 Classification of Diarrhea

Duration Dehydration Status

Acute diarrhea: Abrupt onset, last
less than 2 weeks

Chronic diarrhea: Last longer than 2

weeks, divided into 2 categories:
spesific and non-spesific.
Diagnosis of History
• Duration of diarrhea cough, or other

Diarrhea •
•
Frequency
Present of blood/mucus
important problem (e.g.
convulsion)
• Nausea/ • Food recall
vomitus/abdominal • Risk factors
pain • Symptom of
dehydration or shock

• Presence of fever,
Physical Examination
• General appearance
• Hydration status: lethargy, consciousness, sunken
anterior fontanel, dry mucous membranes, sunken
eyes, lack of tears, poor skin turgor, and delayed
capillary refill
• Increased peristaltic activity (borborygmi)
• Perianal erythema
Laboratory Work Up

Haematology
CBC, Electrolyte, Ureum and creatinine

Faeces
Microscopic and macroscopic

Microbiology
Culture

Radiology
BNO
 Therapy of Diarrhea
Rehydration with ORS
(oralit), use IV line if
the patient doesn’t
want to drink Antibiotic if
Zinc necessary

Feeding : continue breast Wash hands after

feeding and normal diet defecation and before
routine preparing food
Management of Diarrhea
Diarrhea Without Dehydration
Diarrhea Without Dehydration
Diarrhea With Mild-Moderate Dehydration
Diarrhea With Severe Dehydration
 Anti Microbes

Metronidazol 10mg/kg
TID for 5 days (10 days in
Ciprofloxacin 15 severe cases), for severe
Tetracycline 12.5 mg/kg 2 times a day cases : Dehydroemetine
mg/kg divided in 3 for 3 days or hydrochloride 1-1.5
Metronidazole 5 mg/
doses (3 days) or Ceftriaxone 50-100 mg/kg (max 90mg) i.m
until 5 days depends on kg TID for 5 days.
Erythromycin 12.5 mg/kg i.m once a day
mg/kg QID for 3 days IM for 2-5 days. the reaction (for every
age)

Cholera Shigella Amoebiasis Giardiasis

Complications
Dehydration
Acidosis Metabolic

Electrolyte imbalance

Nutritional Disorder

Circulation Disorder
DISCUSSION
 Case Analysis
During hospitalization in RSMH, the
The patient reported to had frequency of diarrhea ±5 times over
vomited. It contained food and previous 24 hours. The feces is yellowish
drink, frequency ±6-8 times, and acidic odor, blood (-), mucus (-).
volume is ¼ glass, projectile Nausea (-), vomitting (-), fever (+), not too
vomitting (-), patient vomit high. There is no seizure, cough or cold.
everytime she consumed foods Patient can drink little by little.
or drinks.

SY Brought to
RSMH
Emergency
1 days Brought to
before RS AK Ghani
but reffered
admission to RSMH
Chief Complaint Diarrhea  stool consistency is because
: Watery Feces watery, frequency ±10 times per day, patient use
volume is ½ - ¾ glass each defecation. JAMSOSKES

Additional Complaint The feces is yellowish and give acidic

: Vomitting odor, blood (-), mucus (-). Patient had
fever, peak 39C. Urination was
normal, cough (-), cold (-), dyspnea (-),
seizure (-). The patient look weak,
irritable, still want to eat and drink,
but vomitting continuosly
 Case Analysis
Sunken
Eyes (+/+)

Mild to Patient
Turgor Failure Oral
still want
goes back Moderate to drink Vomitting Rehydration
slowly (+) Dehydration continuosly
and eat Therapy

Patient
looks
weak and
irritable
 Etiology of Diarrhea
Cholera can also be removed
because it has a distinctive The etiology of diarrhea because ETEC can
smell like rice-washed water also be excluded because diarrhea caused
by ETEC also has a consistency of a soft
bowel.
Cholera

ETEC

Based on the history, the typical symptoms caused by the

Watery stool, with no Presumption The stool was sour
Shigella virus are obtained. Therefore, the diagnosis in this case is
blood, no mucus. and yellowish acute diarrhea ec Rotavirus without dehydration.

EIEC

Shigella, Salmonella, and Salmonella

EIEC can be excluded
because faecal Diarrhea caused by Salmonella has a
consistency in these distinctive odor like rotten eggs and
etiologies is soft, bleeding greenish color, so the etiology of Salmonella
and mucous. can be ruled out
 Therapy and Education
1 tablet of zinc 20 mg Also education to
IVFD RL 75ml/kgBB in 4
per day for 10 wash hands before
hours
consecutive days to preparing food,
accelerate the providing nutritious
reepithelization of the food to children
intestinal mucosa

Education of mothers and Parents are also told

Paracetamol is only families to continue how to deal with
given if temperature ≥ provide additional food diarrhea at home and
38,0ºC so that children's danger signs of
nutritional needs are diarrhea and when to
met. take it to the hospital.
THANK YOU