pendekatan klinis anak dengan diare akut - tulungagung utk peserta

7/23/2019 Pendekatan Klinis Anak Dengan Diare Akut - Tulungagung Utk Peserta

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PENDEKATAN KLINIS DIAREAKUT PADA ANAK

Alpha Fardah Athiyyah, Andy Darma,Reza Ranuh, Subijant !S

Di"i#i $a#trenterl%i Dept&S!F IlmuKe#ehatan Ana' RSU Dr( SetmSurabaya


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Global causes of child (0-59 months) deathsin 2008

Black RE, Cousens , !ohnson "# et al$ Global, %e&ional, and national causes of child mo%talit' in 2008 a-


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)urden * Diarrheal Death# in A#ia Pa+i+

.da/ted f%om Black RE et al$ Global, %e&ional, and national causes of child mo%talit' in 2008 a s'stematic anal'sis$#ancet 200* +5 99-8$

% Estimated proportion of

diarrheal deaths in 1-59 mos

Numb

er


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-&.-&/0

5

Denitin 1 A+ute Diarrhea

In+rea#ed 2uid +ntent * the #tl ab"e the nrmal"alue * appr3imately /4 mL&'%&d( U#ually, thi##ituatin implie# an in+rea#ed *re5uen+y * b6elm"ement#, 6hi+h +an ran%e *rm 7 t 0 t mrethan .4 time# per day(

In+rea#ed *re5uen+y 6atery #tl# mre than 8 time#per day

Relati"e t the u#ual habit# * ea+h indi"idual


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Osmotic

Lactase def.

Lactose intol.

Non absorbable

substance

Osmotic effectWater retained

Large volume

diarrhea

Ecessive secretion

of fluid and electrol!te

"nduced b! e.toin#

hormone produced b!

tumorLarge volume diarrhea

Ecessive motilit!

$ecrease

transit

surface mucosal

contact absorption

Large volume

diarrhea

&ecretoric 'otile

1.RR"E.


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In2ammatry

In2ammatin ( de+rea#ed mu+#al #ur*a+e area 9&:r

+lni+ reab#rptin( )ld 9 in+rea#ed ;)


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Ne6 Re+mmendatin# n the!ana%ement * Diarrhea


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-&.-&/0 9

Etil%y * Diarrhea

Infective Noninfective

Viruses

Bacteria

Parasites Fungi

Allergic

IBD

Celiac disease

InappropriatefeedingFoodintolerance

Climate


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Diarrhea


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Relati"e de%ree * in"a#i"ene## *the r%ani#m# +au#in% diarrhea

Lumen

!u+#a

Submu+#a

12

Salmnella

Shi%ella Rta"iru#


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13

Rta"iru#


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"i&hl' conta&ious

S!ALLin*e+ti"ed#e

Up t /4//"iralparti+le# #hed per

%ram * #tl

Sheddin% be%in#be*re #ymptm#and per#i#t#

a*ter illne##

table in the

eni%onmentS

Remain#

in*e+ti"ein #tl#*r A;EEK

3ische% 4 et al 6accine 2007* 2279-57,enneh' " ediat% 1nfect is ! 2000*90+5* #inha%es .C, B%esee !$ an.m ! ub "ealth 2000*8(5)+05++0* a%asha% : et al, Eme%& 1nfect is 9987(7)550* 1ma&e Ross hitake%;Gett'

Rotai%us


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Path%ene#i# * rta"iru# diarrhea16

A( !ature enter+yte 6a# in*e+ted)( ?iru# multipli+atin dama%ed a*ter .7 hur#


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In+ubatin perid 1 7- hur# Fe"er Nau#ea and "mitin%

;atery diarrhea Lethar%y 9 irritable Re#piratry #ymptm# Anre3ia La+t#e intleran+e Dehydratin and a+id#i# Serum ele+trlyte imbalan+e


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La+ta#e bru#hGbrder enzyme Rta"iru# in*e+tin +au#e %ut ephithelial

dama%e

!re #e"ere in malnuri#hed +hildren Need eliminatin * la+t#e *rm the diet Ln%er time *r re+"ery in

malnuri#hed +hildren Per#i#tent diarrhea p#tGenteriti##yndrme

La+t#e intleran+e 9Rta"iru#

19


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Labratry Dia%n#i#

Anti%en dete+tin *the "iru# in #tl#pe+imen#

Immunl%i+ala##ay# BELISA+nrm the pre+en+e* a "iral +ap#id

prtein


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Shi%ella21


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@uman# are the nly natural h#t# *r Shi%ella( ;rld6ide, the in+iden+e * #hi%ell#i# i# hi%he#t

amn% +hildren / t 7 year# * a%e ;herea# mrtality +au#ed by #hi%ell#i# i# rare in

6e#tern +untrie#, it i# a##+iated 6ith #i%ni+antmrtality 9 mrbidity in de"elpin% 6rld

7 #pe+ie#, ie S( dy#enteriae, S( 2e3neri,S( bydii,and S( #nnei

Prdu+e t3in 1 Entert3i+ Neurt3i+

Shi%ella in"ade# +lni+ mu+#a 9 +au#e# +ell

ne+r#i#


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Shi%ella In*e+tin


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In+ubatin perid i# *rm /. t 7- hur#( Symptm# be%in 6ith #udden n#et *

hi%hG%rade *e"er, abdminal +ramp# 9

6atery diarrhea Sub#e5uently the diarrhea be+ame mu+id,

* #mall "lume 9 mi3ed 6ith bld( Thi# i#a++mpanied by abdminal pain, tene#mu#

9 ur%en+y( Fe+al in+ntinen+e may ++ur( Phy#i+al #i%n# are th#e * dehydratin

be#ide *e"er, l6er abdminal tenderne## 9nrmal r in+rea#ed b6el #und#(

C#1


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Stl mi+r#+py re"eal# pre#en+e *R)< 9 pu# +ell# 6ith mu+u#


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Dehydratin i# the m#t +mmn+mpli+atin * #hi%ell#i#

$a#trinte#tinal ri#' ie re+tal prlap#e, t3i+

me%a+ln, mild hepatiti#, #epti+emia Sy#temi+ +mpli+atin i(e @US, DI#1C.41=ak%ofa& sedikit FF

Eosinol FF Ha%an&

Basol FF -

Ch$ #e'den % I -


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Dia%n#ti+ andE"aluatin


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Clinical Types of DiarrhoealDiseases


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@i#tryPhy#i+al e3aminatin

Labratry e3aminatin


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.4EG=R1 4.


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Rasa hausBAK sedikit kurang

Ditambah tanda

Tonisitas jaringan- turgor kulit- ubun-ubun besar cekung- mata cowong

Ditambah tanda

- Gangguan kesadaran- Sesak, nafas ceat dan dalam- Gangguan eredaran darah

Dehidrasi ringanDehidrasi ringan

Dehidrasi beratDehidrasi berat

Dehidrasi sedangDehidrasi sedang

!enentu'an derajatdehidra#i


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Ne6 Re+mmendatin# n the!ana%ement * Diarrhea


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$lbal Diarrhea Treatment Pli+y

Treatment * dehydratin 6ith :RS #lutin Br 6ith an intra"enu#ele+trlyte #lutin in +a#e# * #e"ere dehydratin

Pr"ide +hildren 6ith .4m% per day * zin+ *r /4G/7 day#


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/( Rehidra#i

) Se#uai derajat dehidra#i* Tanpa dehidra#i ren+ana terapi A* Den%an dehidra#i ta' berat ren+ana

terapi )* Den%an dehidra#i berat ren+ana terapi

ulai dibe%i cai%an 16 (int%aena) se&e%a$ Bila /ende%ita bisaminum,

be%ikan o%alit, se@aktu cai%an 16 dimulai$ Be%i 00ml;k&BBcai%an Rin&e%

#aktat (atau cai%an no%mal salin, atau %in&e% asetat bila %in&e%

laktat tidakte%sedia), seba&ai be%ikut

iulan&i la&i bila den'ut nadi masih lemah atau tidak te%aba


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lan e&%ee of

deh'd%ation

Estimation of

Muid

4'/e of

solution

Route of

t%eatment

. ode%ate -9N

>ild

0ml;k&;+h

50ml;k&;+h

";=R

";=R

1;int%a &ast%ic

=%al;i;int%a&ast%ic

C ee%e +0ml;k&;h Rin&e%#actate

i

Pediatri+ Fluid Rehydratin Bi#hypnatremia Setm @#pital

Ne&8 ! 1 D/4H4,/- Na


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!aintenan+e @.: need# 1

=0

Pediatri+ Fluid Therapy Prin+iple#

ei&ht in & "2= Muid needs

/ G /4 /44 ++&'%&day

// G .4 /444O04++&'%&day

.4 /044O.4++&'%&day

A 12> .r "!"r( 0C


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:ralit Lama ?S :ralit )aru

=%alit #ama =%alit Ba%u

Untu' Klera Untu' 'lera dan nn 'lera

Ri#i' hipernatremia pada nn'lera

Dibuat 'arena banya' lapranhipernatremia

:#mlarita# lebih tin%%i :#mlarita# lebih rendah

Kandun%an) Natrium #ebanya' C4

mml&L) Kalium .4 mml&L) Sitrat /4 mml&L) Klrida -4 mml&L) $lu'#a /// mml&L) Den%an ttal #mlarita#

8// mml&L

Kandun%an) Natrium 0 mml&L) Kalium .4 mml&L) Klrida 0 mml&L) Sitrat /4 mml&L) $lu'#a 0 mml&L) Ttal #mlarita# .70

mml&L


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Redu+ed :#mlarity

:RS Slutin Stl utput i# redu+ed by .0 t 84H

?mitin% i# redu+ed by 84H, and

The need *r un#+heduled I? 2uid# i# redu+ed bymre than 80H

The !le+ular pr+e## *


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The !le+ular pr+e## *:RT


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Se"ere !alnutritin

D nt u#e the I? rute *r rehydratin e3+ept in

+a#e# * #h+'

ReS!al 0ml&'%&84 minute# *r r#t . hr# then 0G

/4 ml&'%&h *r the ne3t 7G/4 hr#

ReS!al 1 8(0mml Na, 74mml K and 8 mml !%

per litre


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.( Du'un%an Nutri#i

) Tetap diteru#'an #e#uai umur ana'

menu #ama pada ana' #ehat) ASI tetap diteru#'an *re'uen#i lebih

#erin% dari bia#anya) Tujuan men+e%ah %izi buru') Adanya perbai'an na*#u ma'an *a#e

'e#embuhan


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8 S l t i i


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8( Suplementa#i/inc

) Pemberian zin+* !en%uran%i lama dan beratnya diare* !en+e%ah berulan%nya diare #elama .G8 bulan* !en%embali'an na*#u ma'an ana'

) D#i# zin+ untu' ana'* Ana' di ba6ah umur bulan 1 /4 m%B/&. tablet per

hari* Ana' di ata# umur bulan 1 .4 m% B/ tablet per hari

) Diberi'an #elama /4G/7 hari berturutGturutme#'ipun ana' #udah #embuh dari diare


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!e+hani#m# * A+tin * QIN

pendekatan klinis anak dengan diare akut - tulungagung utk peserta

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