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    Diarrhoea (Part 2) 2

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    meli tsw
    Here are the answers: 1. Dehydration status: Some dehydration (5-10% fluid loss) 2. Amount of fluids will be given: Approximately 80-120 mL/kg of ORS or other appropriate rehydration solution over 4 hours. 3. If the baby isn't able to drink, intravenous fluids will be needed. 4. If the baby drinks normally, the dehydration is oral rehydration. So in summary, this infant has some dehydration which can be treated with oral rehydration solution given frequently and closely monitored since intake and hydration status can change quickly at this age. IV fluids would be needed if oral intake is not sufficient.

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    Diarrhoea (Part 2) 2

    Uploaded by

    meli tsw
    19 views33 pages
    Here are the answers: 1. Dehydration status: Some dehydration (5-10% fluid loss) 2. Amount of fluids will be given: Approximately 80-120 mL/kg of ORS or other appropriate rehydration solution over 4 hours. 3. If the baby isn't able to drink, intravenous fluids will be needed. 4. If the baby drinks normally, the dehydration is oral rehydration. So in summary, this infant has some dehydration which can be treated with oral rehydration solution given frequently and closely monitored since intake and hydration status can change quickly at this age. IV fluids would be needed if oral intake is not sufficient.

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    anak

    Original Title

    Diarrhoea(Part 2) 2

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    Here are the answers: 1. Dehydration status: Some dehydration (5-10% fluid loss) 2. Amount of fluids will be given: Approximately 80-120 mL/kg of ORS or other appropriate rehydration solution over 4 hours. 3. If the baby isn't able to drink, intravenous fluids will be needed. 4. If the baby drinks normally, the dehydration is oral rehydration. So in summary, this infant has some dehydration which can be treated with oral rehydration solution given frequently and closely monitored since intake and hydration status can change quickly at this age. IV fluids would be needed if oral intake is not sufficient.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    19 views33 pages

    Diarrhoea (Part 2) 2

    Uploaded by

    meli tsw
    Here are the answers: 1. Dehydration status: Some dehydration (5-10% fluid loss) 2. Amount of fluids will be given: Approximately 80-120 mL/kg of ORS or other appropriate rehydration solution over 4 hours. 3. If the baby isn't able to drink, intravenous fluids will be needed. 4. If the baby drinks normally, the dehydration is oral rehydration. So in summary, this infant has some dehydration which can be treated with oral rehydration solution given frequently and closely monitored since intake and hydration status can change quickly at this age. IV fluids would be needed if oral intake is not sufficient.

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    © All Rights Reserved
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    of 33

    DIARRHOEA

    (2)
    ANTIMICROBIAL

    Acute Diarrhoea
    (WHO)

    1. Cholera
    2. Shigellosis
    3. Amoebiasis
    4. Giardiasis
    ANTIMICROBIAL (WHO,1992)

    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 1
    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

    1
    Resistent 3
    ANTIMICROBIAL (WHO,2005)

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


    3 days
    2. SHIGELLA DYSENTERY CIPROFLOXACIN 15 mg/KgBW/x- 2 x a day
    3. 5 days *
    3. AMOEBIASIS METRONIDAZOLE 10mg/Kg BW/x - 3 x a day
    5 days
    4. GIARDIASIS METRONIDAZOLE 5 mg / Kg BW/x - 3 x a day
    5 days

    * Toxis for childrenCefixime 4 mg/KgBW/x- 2 x a day 3-5


    days
    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
    ANTIDIARRHOEAL
    (United States F.D.A)

    A drug that can be shown by objective


    measurement to treat or control the symptoms
    of diarrhoea

    1. Bowel Movement
    2. Stool Consistency
    3. Cramps
    Antidiarrhoeal
    1.UNABSORBED 3. ADSORBENT :
    ANTIMICROBIAL : -Kaolin/pectin
    -Streptomycin -Charcoal
    -Neomycin -Atapulgit / smectite
    -Hydroxyquinolin
    -Unabsorbed Sulfa 4. ANTISECRETORY :
    -Salicylate Acid
    2. ANTIMOTILITY : -Chlorpromazine
    -- Loperamide
    -- Diphenoxylate 5. TRIAL:
    -Lactobacillus,
    -Fructooligo saccharida

    NB : 1 to 4 NO RECOMMENDED
    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
    ( SMON)
    OPIATES & SPASMOLYTICA

    1. INCREASE THE DURATION OF FEVER


    2. PROLONG PASSAGE OF PATHOGENS
    3. DECREASE OF BOWEL PERISTALSIS
    4. INCREASE THE DURATION OF
    PROLIFERATION,TOKSIN PRODUCTION &
    INVASIVE BY MICROORGANISMS
    5. GUT PARALYSIS
    DIARRHOEA

    DEHYDRATION COMPLICATION

    REHYDRATION - ELECTROLYTES
    IMBALANCE
    -RINGERS LACTATE - ACIDOSIS METABOLIC
    -RINGERS ACETATE - FEVER
    -ORS - CONVULTION
    - HYPOGLICEMIA
    ELECTROLYTES - ACID BASE

    INITIAL REHYDRATION

    DIAGNOSIS TREATMENT
    ELECTROLYTES ACID BASE

    INITIAL REHYDRATION

    ISONATREMIA HYPONATREMIA
    DEHYDRATION

    DILUTIONAL
    DEHYDRATION + ACIDOSIS METABOLIC

    REHYDRATION

    ACIDOSIS METABOLIC

    pH < 7.2

    HCO3- = 1-2 mEq/Kg BW

    - LUNGS DYSFUNCTION (-)


    - HYPOKALEMIA (-)
    DEHYDRATION + HYPERNATREMIA

    REHYDRATION

    HYPERNATREMIA
    ( > 150 mEq/l)

    - IVFD STOPPED
    - PLAIN WATER
    DEHYDRATION + HYPONATREMIA

    REHYDRATION

    HYPONATREMIA
    ( < 135 mEq/L)

    Asympt Sympt After


    HypoNa HypoNa Rehydration

    RL NaCl 3% Fluid Restriction

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


    DEHYDRATION HYPO/ HYPERKALEMIA

    REHYDRATION
    HYPOKALEMIA HYPERKALEMIA

    Renal Function
    Diarrhoea (+) Diarrhoea
    Acute Renal Failure
    RL ECG

    Fluids
    N Abnormal
    Restriction

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

    TEMPERATURE DOWN

    COOLING DRUGS

    - Unclothed 1. Paracetamol :
    - Wipe of sweat 30 mg/Kg/day - 3 doses
    - Fanning 2. - Acetyl Salicylic Acid
    - Tepid sponging - 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)
    - Biotype - Eltor
    - Classic

    - Serotype - Ogawa
    - Inaba
    - Hikojima O2 - 138 O139
    O140 - 142

    Bengal Strain
    ENTEROTOXIN

    Absorption of Na+ Surface Receptor


    in Villous Cells are intact

    Adenyl Cyclase

    C - AMP

    Secretion of Cl-
    in Crypt Cells
    Absorption

    Bowel Lumen
    Villi

    Secretion

    Crypt
    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
    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 - FEVER


    - BLOODY DIARRHOEA - CONVULSION
    - TENESMUS - SEPTIC
    - ABDOMINAL PAIN - HEMOLYTIC UREMIC
    - URGENCY 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
    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
    LIMA LINTAS
    TATALAKSANA
    Exercise :
    Infant 10 months of age, was admitted to hospital with
    diarrhoea.
    On examination : BW = 8 kg; infant well & alert;
    eyes : sunken ; drinks eagerly; skin pinch goes
    back:quickly.
    Question :
    1.Dehydration..
    2.Amount of fluids will be given
    3.If the baby arent able to drink, what kind of
    intervention is needed?
    4.If the baby is drinks normally, what type of
    dehydration?

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