DIARRHOEA

DIARRHOEA
IN
IN PEDIATRICS
PEDIATRICS

SUB DIVISION OF PEDIATRICS GASTROENTERO-HEPATOLOGY

DEPARTMENT OF CHILDHEALTH
SCHOOL OF MEDICINE,UNIVERSITY OF NORTH SUMATERA
ADAM MALIK HOSPITAL MEDAN

DIARRHOEA

VOLUME OF WATER
IN THE STOOLS

LOOSE

WATERY
2

HYPERSECRETION
WATER
MALABSORPTION

MALDIGESTION
HYPEROSMOLAR
PERISTALSIS
AREA FOR
ABSORPTION
3

DIARRHOEA
- FREQ. 3X / DAY
- CHANGING OF CONSISTENCY
- WITH/ WITHOUT VOMITING
- WITH/ WITHOUT BLOODY STOOL

ACUTE WATERY
DIARRHOEA

< 14 DAYS

DYSENTERY
FORM

BLOODY
DIARRHOEA

PERSISTENT

SEVERE
MALNUTRITION

> 14 DAYS
4

BABIES FED ONLY BREAST MILK OFTEN

FREQUENT PASSING OF FORMED STOOLS
( 5-6 x / DAY )

THIS ALSO NOT DIARRHOEA

- VIRAL
- FUNGAL
- BAKTERIA
- PARASITE

INFECTION

INFLAMMATION
DIARRHOEA

NON INFECTION

NONINFLAMMATION

- ALLERGY
- etc

- HORMONAL
- ANATOMICAL
- etc

VIRAL DIARRHOEA

1. ROTAVIRUS 6 MONTHS TO 2.5 YEARS

2. NORWALK VIRUS
3. ENTERIC ADENOVIRUS
4. ASTROVIRUS
5. CALICI VIRUS
6. CORONA VIRUS
7. SMALL ROUND VIRUS
- PARVOVIRUS LIKE AGENT
- MINI ROTAVIRUS
- MINI REOVIRUS
7

PRACTICALY
-LIQUID STOOLS 3 X/ DAY
-WITH/ WITHOUT VOMITING
-WITH/ WITHOUT MUCOUS/
BLOOD IN THE STOOLS

CLASSIFICATION
1. AGE
2. ONSET
3. ETIOLOGY
4. SEVERITY
5. PATHOGENESIS
6. HOST DEFENCES
7. SOURCE OF INFECTION
8. EPIDEMIOLOGY
9. SITE OF PATHOLOGY
10. WHO ( 2OO5 )
9

1.AGE
-NEONATAL DIARRHOEA
-INFANTILE DIARRHOEA
-CHILDHOOD DIARRHOEA
2. ONSET
-ACUTE DIARRHOEA : < 7 DAYS (90-95%)
-PROLONGED DIARRHOEA: 7-14 DAYS
-CHRONIC DIARRHOEA : > 14 DAYS
3. ETIOLOGY
-INFLAMMATION

: INFECTION/NON INFECTION

-NON INFLAMMATION
10

4. SEVERITY( WHO, 1984)

-MILD DIARRHOEA : < 1x / 2 hours or < 5cc / KgBW /hours
-SEVEREDIARRHOEA: > 1x / 2 hours or > 5 cc/KgBW/hours
5.HOST DEFENCE
-IMMUNOCOMPETENT
-IMMUNOCOMPROMISED
6. SOURCE OF INFECTION
-NOSOCOMIAL
-COMMUNITY
11

7. PATHOGENESIS
ABSORPTIVE/
1. FASTING

OSMOTIC
STOPS

SECRETORY
CONTINUES

2. STOOL OSM.

400

280

3. Na +

30

100

4. K+

30

40

5. (Na+K)x 2

120

280

6. SOLUTE GAP

280

12

8. EPIDEMIOLOGI
-ENDEMIC
-EPIDEMIC
-MIXED

9. SITE OF PATHOLOGY
-SMALL INTESTINE : CHOLERA, ETEC, ROTAVIRUS
AND G. LAMBLIA DIARRHOEA
-LARGE INTESTINE: SHIGELLOSIS, AMOEBIASIS
-BOTH : CAMPYLOBACTERIOSIS, SALMONELLOSIS
13

10. WHO (2005)

-ACUTE WATERY DIARRHOEA
-PERSISTENT DIARRHOEA
-DYSENTERY DIARRHOEA
-DIARRHOEA WITH SEVERE MALNUTRITION

14

MIKROORGANISMS
GASTRIC ACID
MULTIPLICATION
COLONIZATION
ADHERENT
ENTEROTOXIN

- INVASION
- DAMAGE

HYPERSECRETION

MALABSORPTION
HYPERPERISTALIS
COLONIC SALVAGE

DIARRHOEA

PATHOGENESIS OF ACUTE INFECTIOUS DIARRHOEA

15

DIARE
Cleasing effect
Pathogens

Defense
Self
SelfLimited
Limited

Loss of

Water and Electrolytes

Nutrients

Dehydration
Hypoglicemia
Starvation
Malnutrition
Water
Waterand
andElectrolytes
Electrolytes
Diets
Diets
16

WATER
ELEKTROLIT
ELECTROLYTES

D
I
A
R
R
H
O
E
A

BASE

DEHYDRATION
Na+ ==> atau
Na+
atau
K+ ==>
K+
==>
Ca2+
Ca2+
==> TETANY
Mg2+ ==>
Mg2+
==>
TETANY
Zn ==>
ACRODERMATITIS
ENTEROPATHICA
Zn ==>ACRODERMATITIS ENTEROPATHICA

METABOLIC ACIDOSIS

NUTRIENTS

- HYPOGLYCEMIA
- STARVATION
- PCM

MUCOSAL
INJURY

- MALABSORPTION
- PROTEIN LOSING ENTEROPATHY.
- SENSITIZATION
- NEC

17

HYPOCALCEMIC
TETANY

HYPOMAGNESEMIC
ALKALOTIC

LOSS OF WATER VIA STOOLS

DEHYDRATION

PLASMA WATER

FEVER

HEMOCONCENTRATION

SHOCK

RBF*

COMA

ARF**

* Renal Blood Flow

** Acute Renal Failure

HYPOVOLEMIA

SYMPATH. DISCHARGE
- HEART RATE
- VASOCONSTRICTION

SIGNS OF DEHYDRATION
1. LETHARGICS TO
COMATOSE
2. SHUNKEN
ANTERIOR
FONTANELLA
3. SHUNKEN EYES
4. ABSENT OF
TEARS
5. DRY OF MOUTH
AND TONGUE
6. TACHYCARDIA

7. HYPOTENSION
8. WEAKNESS OF
RADIAL PULSE
9. OLIGURIA/ANURIA
10.TURGOR
11. COOL MOIST
EXTREMITES
12. BW

20

DEHYDRATION

VOLUME

-SOME DEHYDRATION
= 5 - 10 % BB
-SEVERE DEHYDRATION
= > 10% BB

PLASMA SODIUM

ISONATREMIA
= 135 - 150 mEq/L

HYPO/HYPER
NATREMIA

THE
THEOBJECTIVE
OBJECTIVE OF
OFTREATMENT
TREATMENTACUTE
ACUTEDIARRHOEA
DIARRHOEA
DEHYDRATION PROTEIN CALORI
MALNUTRITION
PREVENTION

TREATMENT

WATER & ELECTROLYTES FEEDING

DURATION,
SEVERITY,
EPISODES

ZINC

22

A NEW EPISODE OF DIARRHOEA

DIARRHOEA OCCUR AFTER TWO FULL DAYS

WITHOUT DIARRHOEA

23

MANAGEMENT
ASSESSMENT
1. Degree
of
Dehydration
2. Associated :
Malnutrition
Pneumonia
etc

TREATMENT
1. Water & elektrolytes
2. Diets
3. Drugs
- Zinc
- anti microbial
- Symptomatic
- antidiarrhoeal
24

DEGREE OF DEHYDRATION (WHO,2005)

NO SIGN OF
SOME
SEVERE
DEHYDRATION DEHYDRATION DEHYDRATION
CONDITION

WELL, ALERT

RESTLESS /
IRRITABLE

EYES

NORMAL

SUNKEN

THIRST

NORMALLY, NOT
THIRSTY

THIRSTY, DRINK
EAGERLY

DRINKS POORLY

SKIN TURGOR

QUICKLY

SLOWLY

VERY SLOWLY

NB : 1. READING FROM RIGHT TO LEFT

2. CONSIDERED SEVERE OR SOME DEHYDRATION
IF TWO OR MORE OF THE SIGN ARE PRESENT

LETHARGIC,
FLOPPY, COMA
SUNKEN

FLUIDS TREATMENT
REHYDRATION

INITIAL

REPLETION

MAINTENANCE

NORMAL

HOLLIDAY
SEGAR

ABNORMAL

CHOLERA
COT
26

HOLLIDAY - SEGAR

10 kg
10 - 20 kg
> 20 kg

100 mL / kg
1000 mL + 50 mL/ kg
for each > 10 kg
1500 mL + 20 mL/ kg
for each > 20 kg

NB : 100 mL 2,5 mEq Na+

2 mEq K+
100 calori

REHYDRATION
ORAL
ORS*

I.V.
RINGERS LACTAT

( ORALIT@) RINGERS ACETATE

* Oral Rehydration Salts

28

PREVIOUS STANDART WHO ORAL

REHYDRATION SALTS (ORS)
1.ISOTONIC
2.Na+ equivalent with plasma (90 mEq/l)
3. GLUCOSE = 2 - 3%
4. K+ ( higher than plasma 20 mEq/l )
5. BASE = 30 - 48 mEq/L
29

 CHO
Peptide
Amino Acid

Na+

LUMEN

water
Na+
2K+

ENTEROCYTES

3Na+
BLOOD VESSELS

MECHANISM OF ACTION ORS

BASEMENT
MEMBRANE
LAMINA
PROPRIA
30

ORAL REHYDRATION SALTS (WHO)

PREVIOUS
(mmol/L)
Na
K
Cl
Citrat
Glukose

90
20
80
10
111
311

NEW
(mmol/L)
75
20
65
10
75
245
31

NEW (LOW OSMOLARITY) WHO

ORAL REHYDRATION SALTS

STOOL OUTPUT = 20%

VOMITING = 30%
THE NEED FOR SUPPLEMENTAL I.V
FLUID = 33%

BOWEL LUMEN

BLOOD VESSELS

ORS SOLUTION
SUGAR SOLUTION
SALT SOLUTION

DIARRHOEA

RESOMAL(REHYDRATION SOLUTION FOR MALNUTRITION

=Dissolve 1 new ORS packed into 2 L of clean water
=Add 45 mL of KCl solution ( from stock solution containing
100 g KCl/L)
=Add and dissolve50 g sucrose

Na= 37,5 mEq/L

K=40 mEq/L
Sugar= 25 g/L
34

INDICATION OF I.V FLUIDS

1. SEVERE DEHYDRATION
WITH/WITHOUT SHOCK
2. SEVERE DIARRHOEA
3. INTAKE BY MOUTH
4. GLUCOSE MALABSORPTION
5. ABDOMINAL DISTENTION /
PARALYTIC OBSTRUCTION
6. OLIGURIA / ANURIA FOR
SEVERAL HOURS

35

DEHYDRATION
NO SIGN OF

SOME

SEVERE

< 5%

5 - 10%

> 10%

A. NO SIGN OF DEHYDRATION
1. ORALIT
< 2 years = 50 - 100 mL / x loose stool
2 10 years = 100 - 200 mL/ x loose stool
older children : as much fluid as they want
2. GIVE THE CHILD MORE FLUIDS AND FOOD
THAN USUAL
TO PREVENT DEHYDRATION & MALNUTRITION

3. ZINC 10 20 mg/day10 - 14 days

37

B. SOME DEHYDRATION

ORALIT 75 mL/kg BW /3 a 4 hours

INDICATION
Ringers Lactate
Ringers Acetate
38

C. SEVERE DEHYDRATION
100mL/ kgBW/3-6 hours

< 1 years * initial = 30 CC/kgBW/1 hours

* repletion= 70 cc/kgBW/5 hours

> 1 years * initial = 30 cc/kgBW/ hours

* repletion = 70 cc/kgBW/2 hours
39

ORALIT
PREVENTION
TREATMENT
MAINTENANCE

DEHYDRATION

DIARRHOEA
40

DIARHOEA
REHYDRATION
ANURIA/OLIGURIA
RENAL
FAILURE
FLUIDS

ADEQUATE
URINE *

PHYSIOLOGIC NO PROBLEM
OLIGURIA
FLUIDS

NB : 1. * 1 cc / kg BB / jam
2. Oliguria : < 400 cc / m2 / hari

41

Renal
Failure

Physiologic
Oliguria

diuresis (-)

diuresis (+)

Laboratorium
Urine osmolality
(mOsm/kgH2O)

<350

>500

Na+ urin (mEq/l)

> 40

<20

Fr. excr of Na+

>1%

<1%

Lasix

Fractional Na urin/Na plasma

100%
excretion
42
Cr. urin/Cr. plasma
of Na+

FEEDING
AFTER REHYDRATION
NO RETURN OR WORSENING
OF DIARRHOEA
TOLERANCE TEST
BREASTMILK
SUB BAGIAN GE BIKA FKUSU: FORMULA MILK STOPPED
4-6 MONTHS OF AGE : BREAST MILK + OTHER FOODS
PROBLEM: < 4 MONTHS OF AGE WHO ARE NOT
BREASTFED
MTBS : FORMULA MILK(-)
WHO ( 2005 ) : FORMULA MILK CONTINUED
43

BUKU MANAJEMEN TERPADU BALITA SAKIT (MTBS) WHO

44

ANTIMICROBIAL
Acute Diarrhoea
(WHO)

1. Cholera
2. Shigellosis
3. Amoebiasis
4. Giardiasis
45

ANTIMICROBIAL (WHO)
1.

CHOLERA

TETRACYCLIN 12,5 mg/Kg BW - 4 x a day

3 days

2.

SHIGELLA DYSENTERI 5 mg TMP + 25 mg SMX/Kg BW - 2 x a day

5 days

3. AMOEBIASIS

METRONIDAZOLE 10mg/Kg BW - 3 x a day

5 days

4. GIARDIASIS

METRONIDAZOLE 5 mg / Kg BW - 3 x a day
5 days

46

SIDE EFFECT OF ANTIMICROBIAL

1. CHANGING OF INTESTINAL FLORA
2. OVERGROWTH:
- MONILIA
- ENTEROCOCCUS
- ANAEROB
- PSEUDOMONAS
3. MUCOSAL INJURY
4. IRRITATION
5. PSEUDOMEMBRANOUS ENTEROCOLITIS
6. BLOOD DYSCRASIA
7. VOMITING
47

ANTIDIARRHOEAL
(United States F.D.A)
A drug that can be shown by objective
measurement to treat or control the symptoms
of diarrhea
1. Bowel Movement
2. Stool Consistency
3. Cramps
48

Antidiarrheal
1.UNABSORBED
ANTIMICROBIAL :
-Streptomycin
-Neomysin
-Hydroxyquinoline
-Unabsorbed Sulfa
2. ANTIMOTILITY :
-- Loperamide
-- Diphenoxylate

3. ADSORBENT :
-Kaolin/pektin
-Charcoal
-Atapulgit / smectite
4. ANTISECROTORY:
- Salicylate Acid
- Chlorpromazine
5. TRIAL :
-Lactobacillus
-Fructooligosaccharide

NB : Gol 1 s/d 4 NO RECOMMENDED

49

KAOLIN
1. Stimulate viral-tissue penetration
2. No benefit in improving stools consistency
3. Suppress the effect of antibiotics
4. Cosmetic effect
5. Malabsorption
IODOHIDROXY QUINOLINE
1. No benefit
2. In Japan Subacute Myelo Optic Neuropathy

OPIATES & SPASMOLYTICA

1. INCREASE DURATION OF FEVER
2. PROLONG PASSAGE OF PATHOGENS
3. DECREASE OF BOWEL PEWRISTALSIS
4. INCREASE THE DURATION OF
PROLIFERATION,TOXIN PRODUCTION

AND

INVASIVE BY MICROORGANISMS
5. GUT PARALYSIS
51

DIARRHOEA
DEHYDRATION
REHYDRATION
-RINGERS LACTATE
-RINGERS ACETATE
-ORS

COMPLICATION
- ELECTROLYTES
IMBALANCE
- METABOLIC ACIDOSIS
- FEVER
- CONVULTION
- HYPOGLICEMIA

ELECTROLYTES - ACID BASE

INITIAL

DIAGNOSIS

REHYDRATION

TREATMENT

ELECTROLYTES ACID BASE

INITIAL

ISONATREMIA
DEHYDRATION

REHYDRATION

HYPONATREMIA

DILUTIONAL

DIARRHOEA

METABOLIC
ACIDOSIS
ANION GAP
NORMAL

LOSS OF
HCO3-

INCREASED
STARVATION
RENAL
HYPOPERFUSION
TISSUE HYPOXIA
SALICYLATE
INTOXICATION 55
INBORN ERROR

ANION GAP = Na+ - (Cl + HCO3-)

NORMAL
NORMAL== 88 16
16 mEq/L
mEq/L
56

METABOLIC ACIDOSIS
1.NAUSEA, VOMITING & ANOREXIA
2.DEPRESSION OF CNS (COMA,
CONVULSION)
3.ARTERIAL DILATATION HYPOTENSION
4.CARDIAC CONTRACTILITY
5.HEART FAILURE
6.VENTRICULAR FIBRILLATION
7.O2 AFFINITY OF Hb ANOXIA
8.KUSSMAUL BREATHING HYPOCARBIA vasoconstriction Cerebral
Blood Flow drowsiness

DEHYDRATION + METABOLIC ACIDOSIS

REHYDRATION

pH , HCO3- , pCO2

pCO2 (calculated) = (1.54 X HCO3-) + 8.36 + 1.11

APPOPRIATE

NO APPROPRIATE

METABOLIC ACIDOSIS

pH < 7.2 ATAU HCO3- < 10 mEq/L

- LUNG DYSFUNCTION (-)
- HYPOKALEMIA (-)
HCO3- = 1-2 mEq/Kg BB

58

NO APPROPRIATE

pCO2 (c)

> pCO2 (lab)

pCO2 (c)

< pCO2 (lab)

METABOLIC ACIDOSIS
+
RESPIRATORY ACIDOSIS

METABOLIC ACIDOSIS
+
RESPIRATORY ALKALOSIS

HCO3OVERSHOOT METABOLIC ALKALOSIS

PARADOXAL ACIDOSIS

59

DOSAGE OF HCO3-

HCO3BB(kg)
HCO3d ? -d
HCO
3

H2CO3

( m g)
= (HCO3- desired - HCO3- actual) X 0,3 X

= 20

HCO3- d =
pCO2

HCO3-a =
HCO3- =
=
=

20 x 0,03 pCO2 = 0,6 pCO2

..(1)
( 1,54 X HCO3-a ) + 8,36 1,11
(2)
pCO2 - 8,36
(O.6 pCO2 - 5)
1,54
0,6 pCO2 - ( 0,6 pCO2 - 5) X 0,3
BB(KG)

1,5 m g/kgBB
60
1 - 2m

G
N
I
N
R
WA

BICARBONATE
1.SLOW INFUSION TO PREVENT :
=OVERSHOOT METABOLIC ALKALOSIS
=ACIDOSIS INTRACELLULER
2.HYPOKALEMIARESPIRATORY PARALYSIS
3.LUNG DYSFUNTION PARADOXAL ACIDOSIS
4.CIRCULATORY INSUFFICIENCY

NaHCO3
I.V.
ADMINISTRATION

CORRECTION
OF ACIDOSIS

SERUM : HCO3- + H +

H2O +
CO2
DECREASING
RESPIRATORY
DRIVE

BLOOD BRAIN
BARRIER
SLOW

CEREBRAL
ACIDOSIS AND
DEPRESSION

BRAIN : HCO3- +
H+
MECHANISM OF PARADOXAL
ACIDOSIS

RAPI
HD
2O +
62
CO2

vasodilatation ICP

Hypercarbia

acidosis intracelluler
anoxia

63

BICARBONAT
1 mEq/kgBB/X
DILUTES : 5-6 X

1 HOUR

TO PREVENT
INTRACRANIAL
BLOOD VESSEL
RUPTURE

OVERSHOOT
METAB.ALKALOSIS
ACIDOSIS
INTRACELLULARE
64

DEHYDRATION + HYPERNATREMIA

REHYDRATION

HYPERNATREMIA
( > 150 mEq/l)

- IVFD STOPPED
- PLAIN WATER

DEHYDRATION + HYPONATREMIA
REHYDRATION
HYPONATREMIA
( < 135 mEq/L)
Asympt
HypoNa

Sympt
HypoNa

After
Rehydration

RL

NaCl 3%

Fluid Restriction

Na+(mEq) = (135 Na+ plasma) x 0,6 x BW (kg)

DEHYDRATION HYPO/ HYPERKALEMIA

REHYDRATION
HYPERKALEMIA
HYPOKALEMIA
Renal Function
Diarrhoea (+)

Diarrhoea

RL

Acute Renal Failure

ECG
N

abN

K+ oral

K+ drip
(upto 3 mEq / kgBW / day)

Fluids
Restriction

FEVER
TEMPERATURE DOWN
COOLING
- Unclothed
- Wipe of sweat
- Fanning
- Tepid sponging

DRUGS
1. Paracetamol :
30 mg/Kg/day - 3 doses
2. - Acetyl Salicylic Acid
- Mefenamic Acid
No recommended

CONVULSION
Diazepam: 1 mg/Kg/day
3 - 4 doses iv/per rectal
Hypoglicemia (<50 mg%)
Coma
Dextr. 10% IV 5 mL /Kg BW
within 5 minutes
Alert

V. CHOLERAE
O1

Non O1
(Non Agglutinable)

- Biotip - Eltor
- Classic
- Serotip - Ogawa
- Inaba
- Hikojima

O2 - 138
O140 - 142

O139
Bengal Strain
70

ENTEROTOXIN

Absorption of Na+
in Villous Cells are intact

Surface Receptor
Adenyl Cyclase
C - AMP
Secretion of Clin Crypt Cells

Absorption

Villi

Bowel Lumen

Secretion

Crypt

V. CHOLERAE
JEJUNUM
- COPIOUS DIARRHOEA
- FISHY RICE WATER STOOLS
- FEVER (-)
- ABDOMINAL PAIN (-)
- RAPID DEHYDRATION & SHOCK
- BIOCHEMICAL (+)
- HISTOLOGY (-)

V. CHOLERAE
JEJUNUM
- COPIOUS DIARRHOEA
- FISHY RICE WATER STOOLS
- FEVER (-)
- ABDOMINAL PAIN (-)
- RAPID DEHYDRATION & SHOCK
- BIOCHEMICAL (+)
- HISTOLOGY (-)

DIAGNOSIS
CHILDREN > 2 YEARS
- CLINIC

SEVERE DEHYDRATION
THE OTHER CHILDREN (+)

DARK FIELD MICROSCOPE

- LAB

CULTURE

DIAGNOSIS
CHILDREN > 2 YEARS
- CLINIC

SEVERE DEHYDRATION
THE OTHER CHILDREN (+)

DARK FIELD MICROSCOPE

- LAB

CULTURE

Th

Water & Electrolytes Ringers

Lactate I.V.
Rehydration & Maintenance
Fecal Sodium
( 88 101 mEq/ L)

FEEDING
ANTIMICROBIAL Tetracycline or
Doxycycline

DYSENTERY SINDROME = BLOODY DIARRHOEA

1. DYSENTERY
- BACILLARY
- AMOEBIC
2. Enterocolitis
- Cows milk allergy
3. Trichuriasis
4. Others

- Entero invasive E coli

- C. jejuni

BACILLARY DYSENTERY
= SHIGELLOSIS

S. DYSENTERIAE
S. FLEXNERI
S. BOYDII
S. SONNEI

COLON

SHIGELLA

INVASIVE

SHIGA TOXIN

INHIBITION OF
PROTEIN SYNTHESIS

CYTOTOXIC

SHIGELLA
- WATERY DIARRHOEA
- BLOODY DIARRHOEA
- TENESMUS
- ABDOMINAL PAIN
- URGENCY

- FEVER
- CONVULSION
- SEPTIC
- HEMOLYTIC UREMIC
SYNDROME
- TOXIC MEGA COLON
- RECTAL PROLAPS

Th
1. WATER & ELECTROLYTES
2. FEEDING
3. - SELF LIMITED
- SEVERE TMP - SMX
Cefixime:
8 mg/kg/day
2 doses
nalidixic acid
ampisilin

SALMONELLOSIS

TYPHOIDAL

ENTERIC FEVER :

-S. TYPHOID

TYPHOID FEVER

-S. PARATYPHOID

PARATYPHOID FEVER

NON TYPHOIDAL : SALMONELLA

GASTROENTERITIS
83

INDICATION OF ANTIMICROBIAL
TREATMENT IN SALMONELLA
GASTROENTERITIS
3 MONTHS OF AGE
2. OLD DEBILITATED PATIENT
3. DYSENTERY FORM ESPECIALLY
ILLNESS > 5 DAYS
4. IMMUNOCOMPROMISED : STEROID,
MALIGNANCY
5. BACTERIAEMIA

ACUTE DIARRHOEA

PERSISTENT DIARRHOEA

PROLONGED MUCOSAL INJURY

=MALNUTRITION
=IRON DEFICIENCY
=ANTIBIOTICS
=COWS MILK
=INFECTION

85

MALABSORPTION OF NUTRIENT
PEM

BACTERIAL OVERGROWTH
AND INFECTION

PROLONGED MUCOSAL INJURY

INEFFECTIVE VILLOUS REPAIR

DECREASED
ENTERIC HORMONE

INCREASED ABSORPTION OF
NATIVE FOREIGN PROTEIN

86

DEGREE OF DEHYDRATION

DEFISIT OF BW

CLINIS (WHO,2005)

87

GOLD STANDART DEGREE F

DEHYDRATION

BW PREILLNESS( X )- BW DURING ILNESS ( Y )

X-Y
x 1OO %
X
88

A. X= 10 Kg

Y= 9,25 Kg

10-9,25
x 100 %= 7,5 %
10 (Some dehydration)

Fluid defisit= 10-9,25=0,75 Kg=750 cc

B. Some dehydration= 7,5 %

BW on admission(Y)=9,25 Kg

X ?

(X-Y)100=7,5 X92,5 X=100YX=100/92,5 X 9,25

=10 Kg

Fluid defisit=10-9,25 = 750 cc

C.

Fact 75 cc/Kg=75 x 9,25= 694 cc

89