Presentasi DIARE AKUT

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Page 1: Presentasi DIARE AKUT


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*DEFINITIONo Acute diarrhea is defined as a greater number of stools (>3

times in 24 hours) of decreased form from the normal lasting

for less than 7 days. If the illness persists for more than 14

days, it is called persistent. If the duration of symptoms is

longer than 1 month, it is considered chronic diarrhea.

o Most cases of acute diarrhea are self-limited, caused by

infectious agents (e.g. viruses, bacteria, parasites), and do not

require medication unless the patient is


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*Risk Factor


Improper disposal of


Lack of proper


Feces contact before

handling food

Improper food

hygiene Improper food


Food exposure to


Consumption of

contaminated water or


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*Causative agents

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*Clinical Manifestations

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*Main Symptoms Causes

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* Clinical Evaluation

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* Levels of Dehydration

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*Caution*Being lethargic and sleepy are not the same.

*A lethargic child is not simply asleep ; the child’s mental

state is dull and cannot be fully awakened ; the child may

appear to be drifting into unconsciousness.

*In some infants and children, the eyes normally appear

somewhat sunken. It is helpful to ask the mother if the

child’s eye are normal or more sunken than usual.

*The skin pinch is less useful in infants or children with

marasmus or kwashiorkor, or obese children.

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*Laboratory examinationsoStool cultures are usually unnecessary for immunocompetent

patients who present within 24 hours after the onset of acute, watery


oIt is usually done if there is sign of lactose intolerance and suspect of


oWhat to look for ? :

Macroscopic : Consistency, Color, Mucus, Blood, Smell

Microscopic : Leukocyte, Erythrocyte, Parasites, Bacteria.

Chemistry : pH, Electrolyte (Na, K, HCO3 )

Blood Gas Analysis and Serum Electrolyte if clinically suspect of acid

base and electrolyte imbalance.

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*Continue..*Epidemiologic clues to infectious diarrhoea can be found

by evaluating the incubation period, history of recent

travel, unusual food or eating circumstances, professional

risks, recent use of antimicrobials, institutionalization,

and HIV infection risks.

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* History details and causes of acute diarrhea

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*Rehydration No signs of dehydration:

*Oral rehydration therapy (ORT) is the administration of fluid by mouth to prevent or correct dehydration that is a consequence of diarrhoea.

*ORT consists of:

• Rehydration — water and electrolytes are administered to

replace losses.

• Maintenance fluid therapy (along with appropriate nutrition).

• 5-10ml/kgBW after every episode of diarrhea or,

• Depends on age:

<1 y.o : 50-100ml

1-5 y.o : 100-200ml

>5 : as needed (fluid other than ORS can be given)

• Continue breastfeeding.

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*Mild Dehydration

75ml/kgBW of oral rehydration solution within 3 hours and 5-10ml/kgBW after every episode of diarrhea.

In case of continuous vomiting, parenteral rehydration should be given :

-Ringer Lactate, KaEN 3B or Nacl.

-Volume depends on body weight – 3-10kg : 200ml/kgBW/day

- 10-15kg : 175ml/kgBW/day

- >15kg : 135ml/kgBW/day

Patients should be monitored in hospital/Primary Health Centre.

Give education to parent about how to do rehydration to their children.

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*Severe DehydrationParenteral rehydration using ringer lactate or ringar

acetate : 100ml/kgBW.

Oral rehydration should be continued when the patient is able to drink (5ml/kgBW).

Age 30ml/kgBW 70ml/kgBW

<12 months 1 hour 5 hours

>12 months 30 minutes 2.5 hours

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*Supplemental zinc therapy *Micronutrient supplementation — supplementation

treatment with zinc (20 mg per day until the diarrhea ceases) reduces the duration and severity of diarrheal episodes in children in developing countries.

*Supplementation with zinc sulfate (2 mg per day for 10–14 days) reduces the incidence of diarrhea for 2–3 months.

*It helps reduce mortality rates among children with persistent diarrheal illness.

*Administration of zinc sulfate supplements to children suffering from persistent diarrhea is recommended by the WHO.

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Age Dosage of Zinc

<6 months 10mg once daily for 10 days

≥6 months 20mg once daily for 10 days

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*Why zinc?*Zinc influences the activity of over 300 enzymes, some of which are responsible for DNA replication and transcription.

*Zinc promotes immunity, skin and mucosal resistance to infection, growth, and development of the nervous system.

*It is also an important anti-oxidant and preserves cellular membrane integrity.

*At the level of gastrointestinal system, zinc restores mucosal barrier integrity and enterocyte brush-border enzyme activity.

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*Zinc continue..*It promotes the production of antibodies and circulating lymphocytes against intestinal pathogens.

*Zinc has a direct effect on ion channels, acting as a K channel blocker of adenosine 3-5-cyclic monophosphate-mediated chlorine secrétions.

*Zinc cannot be stored in the body, and nearly 50% of zinc excretion takes place through the gastrointestinal tract and is increased during episodes of diarrhoea.

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*Diet *An age-appropriate diet — regardless of the fluid used for


*Infants require more frequent breastfeedings or bottle feedings — special formulas or dilutions unnecessary

*Older children should be given appropriately more fluids

*Frequent, small meals throughout the day (six meals/day)

*Energy and micronutrient-rich foods (grains, meats, fruits, and vegetables)

*Increasing energy intake as tolerated following the diarrheal episode


*Canned fruit juices — these are hyperosmolar and can aggravate diarrhea.

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*Probiotics are specific defined live microorganisms, such as Lactobacillus GG (ATCC 53103), which have demonstrated health effects in humans. Controlled clinical intervention studies and meta-analyses support the use of specific probiotic strains and products in the treatment and prevention of rotavirus diarrhea in infants.

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*Drugs *Antidiarrheals have no practical benefits for children with

acute/persistent diarrhea. Antiemetics are usually unnecessary in acute diarrhea management.

1. Antimotility – Loperamide (adults).

2. Antisecretory agent – Bismuth subsalicylate.

3. Adsorbents – activated charcoal, attapulgite.

* Antimicrobial therapy is not usually indicated in children. Antimicrobials are reliably helpful only for children with bloody diarrhea (most likely shigellosis), suspected cholera with severe dehydration, and serious nonintestinal infections (e.g., pneumonia).

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*Antimicrobial continue..

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*Education*Water, sanitation, and hygiene:

• Safe water

• Sanitation: houseflies can transfer bacterial pathogens

• Hygiene: hand washing

*Safe food:

• Cooking eliminates most pathogens from foods

• Exclusive breastfeeding for infants

• Weaning foods are vehicles of enteric infection

*Micronutrient supplementation: the effectiveness of this depends on the child’s overall immunologic and nutritional state; further research is needed.


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*Thank You

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*Cara Pemberian Obat Zinc*Pastikan semua anak

yang menderita diare mendapat obat zinc selama 10 hari bertururt-turut.

*Dosis Obat Zinc (1 tablet = 20 mg)

Umur <6 bulan : ½ tablet/ hari

Umur ≥ 6 bulan : 1 tablet/ hari

* Larutkan ke dalam satu sendok air matang atau ASI, segera berikan pada anak.

* Bila anak muntah sekitar setengah jam setelah pemberian tablet zinc, ulangi pemberian dengan cara memberikan potongan lebih kecil dilarutkan beberapa kali hingga satu dosis penuh.

* Bila anak menderita dehidrasi berat dan memerlukan cairan infus, tetap berikan tablet zinc segera setelah anak bisa minum atau makan