*

*
o 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 immunocompromised.

*
Feces contact before handling food Improper food hygiene Improper food refrigeration

Lack of proper handwashing

Food exposure to flies

Improper disposal of feces

Diarrhea

Consumption of contaminated water or food

*Caution
* Being lethargic and sleepy are not the same. * A lethargic child is not simply asleep ; the childs 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 childs 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.

*
oStool cultures are usually unnecessary for
immunocompetent patients who present within 24 hours after the onset of acute, watery diarrhea.

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

amoebiasis.

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.

*
* 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.

*
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.

* Mild Dehydration 75ml/kgBW

of oral rehydration solution within 3 hours and 510ml/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.

* Severe Dehydration Parenteral rehydration using ringer lactate or ringar acetate :

100ml/kgBW.
Age <12 months >12 months 30ml/kgBW 1 hour 30 minutes 70ml/kgBW 5 hours 2.5 hours

Oral rehydration should be continued when the patient is able

to drink (5ml/kgBW).

*
*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 23 months.

*It

helps reduce mortality rates among children with persistent diarrheal illness. of zinc sulfate supplements to children suffering from persistent diarrhea is recommended by the WHO.

*Administration

Age <6 months

Dosage of Zinc 10mg once daily for 10 days

6 months

20mg once daily for 10 days

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

*Zinc *It

promotes immunity, skin and mucosal resistance to infection, growth, and development of the nervous system. is also an important anti-oxidant and preserves cellular membrane integrity. the level of gastrointestinal system, zinc restores mucosal barrier integrity and enterocyte brush-border enzyme activity.

*At

*
*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 monophosphatemediated chlorine secrtions.
excretion takes place through the gastrointestinal tract and is increased during episodes of diarrhoea.

*Zinc cannot be stored in the body, and nearly 50% of zinc

*An

age-appropriate diet regardless of the fluid used for ORT/maintenance special formulas or dilutions unnecessary

*Infants require more frequent breastfeedings or bottle feedings *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,
vegetables)

and

*Increasing
episode
Avoid:

energy intake as tolerated following the diarrheal

*Canned fruit juices these are hyperosmolar and can aggravate

diarrhea.

* 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.

*
* 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).

* Antimicrobial continue..

*
* 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 childs overall immunologic and nutritional state; further research is needed. * Vaccines

*
*Pastikan
semua anak yang menderita diare mendapat obat zinc selama 10 hari bertururtturut. *Dosis Obat Zinc (1 tablet = 20 mg) Umur <6 bulan : 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