Diare

Pembimbing : dr. Hj. Rini Sulviani, Sp. A, M.Kes

Dibuat oleh : Maria Teressa (2016061102)

KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UNIKA ATMA JAYA
RSUD SYAMSUDIN, SH SUKABUMI
PERIODE 21 NOVEMBER 2017 – 6 JANUARI 2018
 Definisi Diare
• Diare adalah buang air besar (BAB) dengan
konsistensi yang lebih lunak atau cair yang
terjadi dengan frekuensi ≥3× dalam 24 jam
• AAP akut < 14 hari, persisten > 14 hari
• ESPGHAN akut < 7 hari
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION ASSOCIATED FOODS
PERIOD OF ILNESS
Bacillus anthracis 2 days - Nausea, vomiting, malaise, bloody diarrhea, Weeks Insufficiently cooked
weeks acute abd pain contaminated meat
Bacillus cereus 1-6 hr Sudden onset of severe nausea and 24 hr Improperly refrigerated
( enterotoxin) vomiting, Diarrhea may be Present cooked or fried rice, meats
Bacillus cereus 10-16 hr Abdominal cramps, 24-48 hr Meats, stews, gravies, vanilla
(diarrheal toxin watery diarrhea, Nausea sauce
Brucella abortus, 7-21 days Fever, chills, sweating, weakness, headache, Weeks Raw milk, goat cheese made
Brucella melitensis, muscle and joint pain, from unpasteurized milk,
and Brucella suis diarrhea, bloody stools during acute Phase contaminated meats
Campylobacter jejuni 2-5 days Diarrhea, cramps, fever, 2-10 days Raw and undercooked
and vomiting; poultry, unpasteurized milk,
diarrhea may be contaminated water
bloody
Clostridium 12-72 hr Vomiting, diarrhea, blurred vision, Variable (days Home-canned foods with a
botulinum: children diplopia, dysphagia, descending muscle to months) low acid content, improperly
and adults Weakness canned commercial foods, foods
(preformed toxin) held warm for extended periods
Clostridium 3-30 days In infants <12 mo,Lethargy, weakness, Variable Honey, home-canned vegetables
botulinum: infants poor feeding, constipation, hypotonia, poor and fruits, corn Syrup
head control, poor gag and sucking reflex
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION ASSOCIATED FOODS
PERIOD OF ILNESS
Clostridium 8-16 hr Watery diarrhea,nausea, abdomina cramps; 24-48 hr Meats, poultry, gravy, dried or
perfringens toxin fever is rare precooked foods, timeand/
or temperature-abused
Food
Enterohemorrhagic 1-8 days Severe diarrhea that is often bloody, 5-10 days Undercooked beef especially
Escherichia coli abdominal pain and vomiting. Usually, little hamburger, unpasteurized milk
(EHEC) and other or no fever is present. More common in and juice, raw fruits and
Shiga toxin–producing children <4 yr old vegetables (e.g., sprouts), salami
E. coli (STEC) (rarely), contaminated Water
Enterotoxigenic E. 1-3 days Watery diarrhea, abdominal cramps, Some 3 to >7 days Water or food contaminated
coli (ETEC) vomiting with human feces
Listeria 9-48 hr for Fever, muscle aches, and nausea or diarrhea. Variable Fresh soft cheeses,
monocytogenes GI,, 2-6 wk Infants infected from mother at risk for unpasteurized milk,Inadequately
for invasive sepsis or meningitis pasteurized milk, ready-to-eat
disease deli meats, hot dogs
Salmonella spp. 1-3 days Diarrhea, fever, abdominal cramps, vomiting 4-7 days Related to fecal
S. typhi and S. paratyphi  fever, headache, contamination of water supplies
constipation, malaise, chills, and myalgia; or street-vended foods
diarrhea is uncommon, and vomiting is not
usually severe
Shigella spp. 24-48 hr Abdominal cramps, fever, diarrhea, Stools 4-7 days Food or water contaminated
might contain blood and mucus human fecal material
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION ASSOCIATED FOODS
PERIOD OF ILNESS
Staphylococcus 1-6 hr Sudden onset of severe nausea and vomiting 24-48 hr Unrefrigerated/improperly
aureus (enterotoxin) Abdominal cramps, Diarrhea and fever may refrigerated meats, potato
be present and egg salads, cream Pastries
Vibrio cholerae 24-72 hr Profuse watery diarrhea and vomiting, 3-7 days Contaminated water, fish,
(toxin) which can lead to severe dehydration and shellfish, street-vended food
death within hours typically in Asia
Vibrio 2-48 hr Watery diarrhea, abdominal cramps, 2-5 days Undercooked or raw seafood,
parahaemolyticus nausea, vomiting such as fish, shellfish
Yersinia 24-48 hr Appendicitis-like symptoms (diarrhea and 1-3 wk, Undercooked pork,
enterocolitica vomiting, fever, usually unpasteurized milk, tofu,
and Yersinia abdominal pain) Might have a self-limiting contaminated water
pseudotuberculosis Scarlatiniform rash or erythema nodosum Infection
with Y.
Pseudotuberculosis
Hepatitis A 28 days Diarrhea, dark urine, jaundice, and flu-like Variable, Raw produce, contaminated
(15-50 days) symptoms, i.e., fever, headache, nausea, and 2 wk-3 mo drinking water, uncooked foods
abdominal pain
Caliciviruses 1-3 days Vomiting, watery diarrhea, low-grade (4-8 days) Fecally contaminated foods,
(including Fever, Temporary lactose intolerance can Ready-to-eat foods touched
noroviruses and occur in Infants and children by infected food workers
sapoviruses) (salads, fruits)
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION OF ASSOCIATED FOODS
PERIOD ILNESS
Other viral agents 10-70 hr Nausea, vomiting, diarrhea, malaise, 2-9 days Fecally contaminated foods,
(astroviruses, abdominal pain, headache, fever Ready-to-eat foods touched
adenoviruses, by infected food workers
parvoviruses) (salads, fruits)
Angiostrongylus 1 wk-≥1 mo Severe headaches, nausea, vomiting, neck Several weeks Raw or undercooked
cantonensis stiffness, paresthesias, hyperesthesias, to intermediate hosts (e.g., snails
seizures, and other Neurologic several months or slugs), infected paratenic
Abnormalities hosts (e.g., crabs, freshwater
shrimp)
Cryptosporidium 2-10 days Diarrhea (usually watery), stomach May be Any uncooked food or food
cramps, upset stomach, slight fever remitting, contaminated by an ill food
relapsing handler after cooking; drinking
weeks-months water
Cyclospora 1-14 days, Diarrhea (usually watery), loss of May be Various types of fresh produce
Cayetanensis usually appetite, substantial loss of weight, remitting, (imported berries, lettuce)
at ≥1 wk stomach cramps, nausea, vomiting, Fatigue relapsing
weeks-months
Entamoeba 2-3 days–1-4 Diarrhea (often bloody), frequent bowel May be weeks Uncooked/ contaminated food,
histolytica wk movements, lower abdominal pain to months) drinking water
Giardia lamblia 1-2 wk Diarrhea, stomach cramps, gas, weight Days to weeks Uncooked/ contaminated food,
Loss drinking water
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION OF ASSOCIATED FOODS
PERIOD ILNESS
Toxoplasma 5-23 days asymptomatic, 20%  cervical Months contaminated
gondii lymphadenopathy substances (e.g., soil
and/or a flu-like illness with cat feces on fruits and
veggies), raw meat
Toxoplasma In infants at Most infected infants Months Passed from mother to Child
gondii birth have few symptoms at
(congenital birth; later, they
Infection) Develop signs of congenital
Toxoplasmosis
Trichinella 1-2 days Acute: nausea, diarrhea, Months Raw or undercooked
spiralis initial vomiting, fatigue, fever, abdominal contaminated meat,
symptoms; discomfort followed by muscle soreness, usually pork or wild
2-8 wk after weakness, and occasional cardiac and game meat (e.g., bear or moose)
Infection Neurologi complications
 Etiologi Diare Non-infeksi
• Malabsorbsi karbohidrat, kongenital atau didapat
• Diare fungsional, co: diarrhea-predominant irritable bowel
syndrome, “chronic nonspecific diarrhea”
• Inflammatory bowel disease
• Insufisiensi pankreas
• Gangguan motilitas
• Tumor neuroendorkin
• Hipertiroid
• Drug-related
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION ASSOCIATED FOODS
PERIOD OF ILNESS
Antimony 5 min–8 Vomiting, metallic taste self limited Metallic container
Arsenic Few hours Vomiting, colic, diarrhea Days Contaminated food
Cadmium 5 min–8 Nausea, vomiting, myalgia, increase in self limited Seafood, oysters, clams, lobster,
salivation, stomach pain grains, peanuts
Ciguatera fish 2-6 hr Abdominal pain, nausea, vomiting, diarrhea Days to Grouper, red snapper,
poisoning months amberjack, and barracuda (most
common)
Copper 5 min–8 hr Nausea, vomiting, blue or green Vomitus self limited Metallic container
Mercury 1 wk or Numbness, weakness of legs, spastic May be Fish exposed to organic mercury,
longer paralysis, impaired vision, blindness, coma protracted grains
Mushroom toxins, <2 hr Vomiting, diarrhea, confusion, visual Often fatal Wild mushrooms (cooking
short-acting disturbance, salivation, diaphoresis, might not destroy these
(muscimol,muscarine, hallucinations, disulfiram-like reaction, toxins)
psilocybin, Coprinus confusion, visual Disturbance
atramentaria,
ibotenic acid)
Mushroom toxins, 4-8 hr Diarrhea, abdominal cramps, leading Often fatal Mushrooms
long-acting (amanitin) diarrhea; to hepatic and renal failure
Nitrite poisoning 1-2 hr Nausea, vomiting, cyanosis, headache, Usually Cured meats, any contaminated
Nausea dizziness, weakness, loss of consciousness, selflimited foods, spinach exposed to
chocolate-brown Blood excessive nitrification
 ETIOLOGY INCUBATION SIGNS AND SYMPTOMS DURATION ASSOCIATED FOODS
PERIOD OF ILNESS
Pesticides minutes to Nausea, vomiting, abdominal cramps, self limited Any contaminated food
hours diarrhea, headache, nervousness,blurred
vision, twitching, convulsions, salivation,
meiosis
Puffer fish <30 min Paresthesias, vomiting, diarrhea, abdominal Death usually Puffer fish
(tetrodotoxin) pain, ascending paralysis, respiratory failure in 4-6 hr
Scombroid 1 min-3 hr Flushing, rash, burning sensation of skin, 3-6 hr Fish: bluefin, tuna, skipjack,
(histamine) mouth and throat, dizziness, urticaria, mackerel, marlin, escolar,
paresthesias and mahi mahi
Shellfish toxins Few Nausea, vomiting, diarrhea, and abdominal hr to 2-3 days A variety of shellfish : mussels,
(diarrheic, neurotoxic, pain accompanied by chills, headache, and oysters, scallops, and shellfish
amnesic) hours fever from the Florida coast and the
Gulf of Mexico
Thallium 30 min-3 hr Nausea, vomiting, diarrhea, painful Several days Contaminated food
paresthesias, motor polyneuropathy, hair
loss
Sodium fluoride minutes to Salty or soapy taste, numbness of mouth, May be Fish exposed to organic mercury,
2 hr vomiting, diarrhea, dilated pupils, spasms, protracted grains
pallor, shock, Collapse
Tin 5 min-8 hr Nausea, vomiting, diarrhea Self limited Metallic container
 Patofisiologi
• Terdapat 4 dasar patofisiologi diare sekretorik, sitotoksik, osmotik, dan disentri. Diare
dapat terjadi akibat kombinasi satu atau lebih dari proses ini

Sekretorik Sitotoksik Osmotik Disentri

Escherichia coli, Vibrio Campylobacter fetus,

cholera, Clostridium Rotavirus, Norwalk Clostridium diffidile,
diffidile, Clostridium agent, Cryptosporidium, Lactose, Sorbitol Salmonella, Shigella, Yersinia
perfringen, Aeromonas Escherichia coli enterocolltica, Entamoeba
hydrophila, histolytica
Staphylococcus aureus,
Vibrio parahaemolyticus,
Bacillus cereus, Shigeila,
Salmonella Yersinia,
Eenterocoiltica, Giardia
lambila, Neuroblastoma
 Sekretorik
• Enterotoksin  stimulasi adenyl
cyclase system. adenil siklase yang
akan mengubah adenosine
triphosphate (ATP) menjadi cyclic
adenosine monophosphate
(cAMP).
• Akumulasi cAMP intraselular
menyebabkan sekresi cairan dan
elektrolit dari mukosa sel kripta ke
lumen intestinal
• Enterotoxin  hambat absorbsi
cairan dan elektrolit di sel vili
 Sitotoksik
• Pada diare yang disebabkan oleh rotavirus, virus masuk ke
saluran cerna  berkembang biak apikal usus halus
menyebabkan kerusakan pada bagian apikal dari vili
• Vili yang rusak  diganti oleh bagian kripta yang belum matang
(imatur, berbentuk kuboid atau gepeng)  tidak dapat berfungsi
normal gangguan penyerapan
• Rotavirus  reduksi aktivitas enzim laktase  menurunkan
reabsorbsi karbohidrat
• Morfologi intestinal dan kapasitas absorbsi membaik dalam 2-3
minggu
 Osmotik
• Substansi tidak terabsorbsi  tekanan osmotik meningkat 
cairan tertarik ke lumen usus  watery diarrhea
• Diare osmotik paling sering disebabkan oleh malabsorpsi
karbohidrat
• Laktosa akan diubah menjadi glukosa dan galaktosa oleh
enzim laktase, kemudian diabsorbsi di dalam usus halus.
• Defisiensi enzim laktase akumulasi laktosa pada lumen usus
akan menimbulkan osmotic pressure yang tinggi diare
 Disentri
• Invasi bakteri  Inflamasi di mukosa dan
submukosa ileum terminal dan kolon 
mukosa edema, bleeding, infiltrasi leukosit 
darah dan leukosit ke lumen, penurunan
absrobsi cairan di kolon  diare berdarah
• Pada diare sekretorik dan disentri 
perubahan motilitas  penurunan tonus
intestinal  peristaltik melambat  dilatasi
lumen sehingga terjadi nyeri abdomen, muntah
• Disentri  terdapat iritasi kolon  BAB sering
dan tenesmus
• Shigella  kematian sel kolon dan ulkus
mukosa
 Komplikasi Extraintestinal
ASSOCIATED ENTERIC PATHOGEN(S) MANIFESTATION

Salmonella, Shigella, Yersinia, Vulvovaginitis, urinary tract infection, endocarditis,

Campylobacter, Clostridium difficile
Salmonella, Shigella, Yersinia,
Campylobacter, Cryptosporidium, C. difficile
Campylobacter
osteomyelitis, meningitis, pneumonia, hepatitis,
peritonitis, chorioamnionitis, soft-tissue infection,
and septic thrombophlebitis
Reactive arthritis
Guillain-Barré syndrome

Shigella, Campylobacter, Yersinia Glomerulonephritis

Yersinia, Campylobacter, Salmonella Erythema nodosum

Shigella dysenteriae 1, Escherichia coli Hemolytic uremic syndrome

O157:H7, others
Campylobacter, Yersinia Hemolytic anemia
Derajat Dehidrasi
 LINTAS DIARE
• Berikan olarit
• Berikan tablet Zinc selama 10 hari berturut-turut
• Teruskan ASI – makan
• Berikan antibiotik secara selektif
• Berikan nasihat pada ibu/keluarga
 Diare Tanpa Dehidrasi (Rencana Terapi A)
Keadaan umum baik, sadar, mata tidak cekung, minum biasa tidak haus, cubitan
kulit perut/turgor kembali segera
1. Berikan cairan lebih banyak dari biasanya
• Asi diteruskan
• Beri oralit sampai diare berhenti, bila muntah tunggu samapa 10 menit dan dilanjutkan
sedikit-demi sedikit
• Umur < 1 tahun  50-100 ml setiap BAB
• Umur > 1 tahun  100-200 ml setiap BAB
• Anak diberi 6 bungkus oralit (200 ml) di rumah bila telah diobati dengan rencana terapi
B atau C, tidak dapat kembali ke petugas kesehatan setiap memburuk
• Ajari ibu cara mencampur dan memberikan oralit

2. Beri obat zinc 10 hari berturut walau diare sudah berhenti. Dapat dikunyah, dilarutkan
dalam 1 sendok air matang/ASI
• Umur < 6 bulan  10 mg per hari
• Umur > 6 bulan  20 mg per hari
3. Beri makanan untuk mencegah kurang gizi
• Beri makan sesuai umur anak dengan menu yang sama ketika sehat
• Tambahkan 1-2 sendok teh minyak sayur setiap porsi makan
• Beri makanan kaya kalium seperti sari buah segar, pisang, air kelapa hijau
• Beri makan lebih sering dan biasanya dengan porsi lebih kecil (setiap 3-4
jam)
• Setelah diare berhenti, beri makanan yang sama dan makanan tambahan
selama 2 minggu

4. Antibiotik hanya sesuai indikasi

5. Nasihat ke ibu/pengasuh agar membawa anak kembali berobat bila BAB cair
lebih sering, muntah berulang, sangat haus, makan dan minum sangat sedikit,
timbul demam, BAB berdarah, tidak membaik dalam 3 hari
 Diare Dehidrasi Ringan/Sedang (Rencana Terapi B)
Gelisah, rewel, mata cekung, ingin minum/ada rasa haus, cubitan kulit
perut/turgor kembali lambat

1. Jumlah oralit yang diberikan dalam 3 jam pertama di sarana kesehatan  75 ml x BB anak
Bila BB tidak diketahui:

Umur s.d. 4 bulan 4-12 bulan 12-24 bulan 2 – 5 tahun

BB < 6 kg 6 – 10 kg 10 -12 kg 12-19 kg
Jumlah (ml) 200-400 400 - 700 700-900 900-1400

Bila anak menginginkan lebih banyak oralit, berikanlah.

• Bujuk ibu untuk meneruskan ASI.
• Untuk bayi < 6 bulan yang tidak mendapat ASI berikan juga 100-200 ml air masak
selama masa ini.
• Untuk anak > 6 bulan, tunda pemberian makan selama 3 jam kecuali ASI dan oralit
• Beri obat zinc 10 hari berturut
 Diare Dehidrasi Ringan/Sedang (Rencana Terapi B)
2. Amati dengan seksama dan bantu ibu memberikan oralit
• Tunjukkan jumlah cairan yang harus diberikan.
•Berikan sedikit demi sedikit tapi sering dari gelas.
•Periksa dari waktu ke waktu bila ada masalah.
•Bila kelopak mata anak bengkak, hentikan pemberian oralit dan berikan air masak atau ASI.
•Beri oralit sesuai Rencana Terapi A bila pembengkakan telah hilang.

3. Setelah 3-4 jam, nilai kembali kemudian pilih rencana terapi A, B, atau C untuk melanjutkan
•Bila tidak ada dehidrasi, ganti ke Rencana Terapi A. Bila dehidrasi telah hilang, anak biasanya kencing
kemudian mengantuk dan tidur.
•Bila tanda menunjukkan dehidrasi ringan/ sedang, ulangi Rencana Terapi B
•Anak mulai diberi makanan, susu dan sari buah.
•Bila tanda menunjukkan dehidrasi berat, ganti dengan Rencana Terapi C

4. Bila ibu harus pulang sebelum rencana terapi B selesai

•Tunjukkan jumlah oralit yang harus dihabiskan dalam Terapi 3 jam di rumah.
•Berikan oralit 6 bungkus untuk persediaan di rumah
•Jelaskan 5 langkah Rencana Terapi A untuk mengobati anak di rumah
 Diare Dehidrasi Berat (Rencana Terapi C)
Lesu, lunglai/tidak sadar, mata cekung, malas minum, cubitan kulit perut/ turgor
kembali sangat lambat
Jika dapat memberikan cairan intravena
• Berikan segera RL atau NaCl 0.9% 100 ml/kgBB dibagi sebagai berikut:
Umur Pemberian 30 ml/kgBB Kemudian 70 ml/kgBB
< 1 tahun 1 jam* 5 jam
>= 1 tahun 30 menit* 2,5 jam

*Diulangi bila denyut nadi masih lemah atau tidak teraba

• Nilai kembali tiap 15-30 menit. Bila nadi belum teraba, beri tetesan lebih cepat.
• Juga beri oralit (5 ml/kg/jam) bila penderita bisa minum; biasanya setelah 3-4 jam (bayi) atau 1-2
jam (anak).
• Berikan obat Zinc selama 10 hari berturut-turut
• Setelah 6 jam (bayi) atau 3 jam (anak) nilai kembali derajat dehidrasi. Lalu pilih rencana terapi A, B,
C untuk melanjutkan terapi
 Jika tidak dapat • Rujuk penderita untuk terapi Intravena.
memberi cairan IV, • Bila penderita bisa minum, sediakan oralit dan
Ya
adakah terapi terdekat? tunjukkan cara memberikannya selama di perjalanan
(30 mnt)
Tidak • Mulai rehidrasi dengan oralit melalui NGT/OGT.
Berikan perlahan, 20 ml/kg BB/jam selama 6 jam
Apakah dapat • Nilai setiap 1-2 jam:
menggunakan Ya
Bila muntah/kembung berikan cairan lebih lambat.
OGT/NGT?
Bila rehidrasi tidak tercapai setelah 3 jam rujuk u/ IV
Tidak • Setelah 6 jam nilai kembali, pilih rencana terapi A,B, C

Apakah penderita bisa • Mulai rehidrasi dengan oralit melalui mulut

Ya
minum? Berikan perlahan, 20 ml/kg BB/jam selama 6 jam
• Nilai setiap 1-2 jam:
Tidak
Bila muntah/kembung berikan cairan lebih lambat.
Bila rehidrasi tidak tercapai setelah 3 jam rujuk u/ IV
Rujuk untuk rehidrasi • Setelah 6 jam nilai kembali, pilih rencana terapi A,B, C
melalui NGT/OGT/IV
 Pemberian ZINC
Zinc diberikan selama 10 hari berturut-turut dengan dosis sebagai berikut:
a. Balita umur < 6 bulan: 1/2 tablet (10 mg)/ hari
b. Balita umur ≥ 6 bulan: 1 tablet (20 mg)/ hari

Pemberian zinc harus tetap dilanjutkan meskipun diare sudah berhenti. Hal
ini dimaksudkan untuk meningkatkan ketahanan tubuh terhadap
kemungkinan berulangnya diare pada 2 – 3 bulan ke depan.
Teruskan ASI dan pemberian Makanan
• Berikan ASI sebanyak yang anak inginkan

• Anak harus diberi makan seperti biasa dengan frekuensi lebih sering. Lakukan ini sampai dua
minggu setelah anak berhenti diare.

• Anak < 2 tahun dianjurkan untuk mengurangu susu formula dan mengganti dengan ASI

• Anak > 2 tahun, teruskan pemberian susu formula, ingatkan ibu untuk memastikan anaknya
mendapat oralit dan air matang.
 Antibiotik
ORGANISM DRUG OF CHOICE, DOSAGE, AND DURATION OF TREATMENT
Shigella (severe dysentery Ceftriaxone 50-100 mg/kg/day IV or IM, qd or bid × 7 days, Ciprofloxacin 20-30 mg/kg/day PO bid × 7-10
and EIEC dysentery) days, Ampicillin PO, IV 50-100 mg/kg/day qid × 7 days
EPEC, ETEC, EIEC TMP 10 mg/kg/day and SMX 50 mg/kg/day bid × 5 days, Ciprofloxacin PO 20-30 mg/kg/day qid for 5-10
days
Salmonella Treatment indicated in infants younger than 3 mo, malignancy, chronic GI disease, severe colitis, (see
shigella treatment)
Aeromonas/Plesiomonas TMP 10 mg/kg/day and SMX 50 mg/kg/day bid for 5 days, Ciprofloxacin PO 20-30 mg/kg/day divided bid ×
7-10 days
Yersinia spp. Antibiotics are not usually required for diarrhea, Deferoxamine therapy should be withheld for severe
infections or associated bacteremia
Campylobacter jejuni Erythromycin PO 50 mg/kg/day divided tid × 5 days, Azithromycin PO 5-10 mg/kg/day qid × 5 days
Clostridium difficile Metronidazole PO 30 mg/kg/day divided qid × 5 days; max 2 g, second line Vancomycin PO 40 mg/kg/day
qid × 7 days, max 125 mg
Entamoeba histolytica Metronidazole PO 30-40 mg/kg/day tid × 7-10 days, Iodoquinol PO 30-40 mg/kg/day tid × 20 days
Paromomycin PO 25-35 mg/kg/day tid × 7 days
Giardia lamblia Furazolidone PO 25 mg/kg/day qid × 5-7 days, Metronidazole PO 30-40 mg/kg/day tid × 7 days,
Albendazole PO 200 mg bid × 10 days
 Nasihat kepada Ibu/Pengasuh
• Berikan nasihat dan cek pemahaman ibu/pengasuh tentang cara
pemberian Oralit, Zinc, ASI/makanan

• Anjurkan untuk segera membawa anak ke petugas kesehatan bila

- Buang air besar cair lebih sering
- Muntah berulang-ulang
- Mengalami rasa haus yang nyata
- Makan atau minum sedikit
- Demam
- Tinjanya berdarah
- Tidak membaik dalam 3 hari
 Pemeriksaan Feses
Makroskopis Mikroskopis Kimia
• Konsistensi • Protozoa • Darah samar
• Jumlah • Telur cacing
• Warna • Leukosit
• Urobilin
• Lendir • Eritrosit • Urobilinogen
• Darah • Sel epitel • Bilirubin
• Bau • Kristal
• Sisa makanan • Makrofag
• Parasit • Sel ragi
 Daftar Pustaka
• Kliegman, R., Stanton, B., St. Geme, J. W., Schor, N. F., & Behrman, R. E. Nelson textbook of
pediatrics (Edition 20.). Phialdelphia, PA: Elsevier; 2016
• Departemen Kesehatan RI. Buku Saku Petugas Kesehatan : Lintas Diare. Jakarta: Departemen Kesehatan RI
Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan, 2011
• Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H ; European Society for Pediatric
Gastroenterology, Hepatology, and Nutrition; European Society for Pediatric Infectious Diseases evidence-
based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr
Gastroenterol Nutr. 2014;59(1):132–152
• Nicholas J. CaJacob, Mitchell B. Cohen. Updates on diarrhea. Pediatrics in Review. 2016;37(8):313-322
• DeWitt TG. Acute diarrhea in children. Pediatrics in Review. 1989.11(1):6-12
• WHO. Readings on diarrhea: student manual. Geneva: World Health Organization; 1992
• WHO. The treatment of diarrhea: a manual for physicians and other senior health workers. Geneva: World
Health Organization; 2005