1

DIARRHOEA

VOLUME OF WATER
IN THE STOOLS

LOOSE WATERY
2
WATER
HYPERSECRETION
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

DYSENTERY
FORM
PERSISTENT
< 14 DAYS
BLOODY
DIARRHOEA
> 14 DAYS
SEVERE
MALNUTRITION
BABIES FED ONLY BREAST MILK OFTEN
FREQUENT PASSING OF FORMED STOOLS
( 5-6 x / DAY )
THIS ALSO NOT DIARRHOEA
DIARRHOEA
INFLAMMATION
NONINFLAMMATION
INFECTION
- VIRAL
- FUNGAL
- BAKTERIA
- PARASITE
NON INFECTION
- ALLERGY
- etc
- HORMONAL
- ANATOMICAL
- etc
6
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


8
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/ SECRETORY
OSMOTIC
1. FASTING STOPS 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 0

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
- INVASION
- DAMAGE
ENTEROTOXIN
MALABSORPTION HYPERSECRETION
HYPERPERISTALIS
DIARRHOEA
PATHOGENESIS OF ACUTE INFECTIOUS DIARRHOEA
COLONIC SALVAGE
15
DIARE
Cleasing effect
Pathogens
Defense
Self Limited
Loss of
Water and Electrolytes
Nutrients
- Water and Electrolytes
- Diets
Dehydration
Hypoglicemia
Starvation
Malnutrition
16
D
I
A
R
R
H
O
E
A
WATER DEHYDRATION
BASE METABOLIC ACIDOSIS
NUTRIENTS - HYPOGLYCEMIA
- STARVATION
- PCM
MUCOSAL
INJURY
- MALABSORPTION
- PROTEIN LOSING ENTEROPATHY.
- SENSITIZATION
- NEC
ELEKTROLIT Na+ ==> atau
K+ ==>
Ca2+ ==>
Mg2+ ==>
Zn ==> ACRODERMATITIS ENTEROPATHICA

ELECTROLYTES


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

TETANY
HYPOCALCEMIC
HYPOMAGNESEMIC
ALKALOTIC
LOSS OF WATER VIA STOOLS
DEHYDRATION
PLASMA WATER
FEVER HEMOCONCENTRATION
HYPOVOLEMIA
SHOCK
RBF* SYMPATH. DISCHARGE
- HEART RATE
- VASOCONSTRICTION
COMA
ARF**
* Renal Blood Flow
** Acute Renal Failure
19
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
DEHYDRATION
VOLUME
PLASMA SODIUM
-SOME DEHYDRATION
= 5 - 10 % BB
-SEVERE DEHYDRATION
= > 10% BB
ISONATREMIA
= 135 - 150 mEq/L

HYPO/HYPER
NATREMIA
21
THE OBJECTIVE OF TREATMENT ACUTE DIARRHOEA
DEHYDRATION

PROTEIN CALORI
MALNUTRITION
WATER & ELECTROLYTES FEEDING
PREVENTION TREATMENT
DURATION,
SEVERITY,
EPISODES
ZINC
22
A NEW EPISODE OF DIARRHOEA
DIARRHOEA OCCUR AFTER TWO FULL DAYS
WITHOUT DIARRHOEA
23
MANAGEMENT
ASSESSMENT TREATMENT
1. Degree of
Dehydration
2. Associated :
Malnutrition
Pneumonia
etc
1. Water & elektrolytes
2. Diets
3. Drugs
- Zinc
- anti microbial
- Symptomatic
- antidiarrhoeal
NO SIGN OF
DEHYDRATION
SOME
DEHYDRATION
SEVERE
DEHYDRATION

CONDITION WELL, ALERT RESTLESS /
IRRITABLE
LETHARGIC,
FLOPPY, COMA
EYES NORMAL SUNKEN 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

DEGREE OF DEHYDRATION (WHO,2005)
25
FLUIDS TREATMENT
REHYDRATION MAINTENANCE
INITIAL REPLETION NORMAL
HOLLIDAY
SEGAR
CHOLERA
COT
ABNORMAL
+
HOLLIDAY - SEGAR
s 10 kg 100 mL / kg
10 - 20 kg 1000 mL + 50 mL/ kg
for each > 10 kg
> 20 kg 1500 mL + 20 mL/ kg
for each > 20 kg
NB : 100 mL 2,5 mEq Na
+
2 mEq K
+



100 calori
27
REHYDRATION
ORAL
ORS*
( ORALIT
@
)
I.V.
RINGERS LA CTAT
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
Na
+
2K
+

LAMINA
PROPRIA
BASEMENT
MEMBRANE
3Na
+

ENTEROCYTES
LUMEN
CHO
Peptide
Amino Acid
Na
+

water
BLOOD VESSELS
MECHANISM OF ACTION ORS
30
ORAL REHYDRATION SALTS (WHO)
PREVIOUS
(mmol/L)
NEW
(mmol/L)
Na 90 75
K 20 20
Cl 80 65
Citrat 10 10
Glukose 111 75
311 245
NEW (LOW OSMOLARITY) WHO
ORAL REHYDRATION SALTS
STOOL OUTPUT ++ = 20%
VOMITING ++ = 30%
THE NEED FOR SUPPLEMENTAL I.V
FLUID ++ = 33%

BOWEL LUMEN BLOOD VESSELS
DIARRHOEA
SUGAR SOLUTION
SALT SOLUTION
ORS SOLUTION
33
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
DEHYDRATION
NO SIGN OF SOME SEVERE
< 5% 5 - 10%
> 10%
A B
C
36
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
ADEQUATE
URINE *
RENAL
FAILURE
PHYSIOLOGIC
OLIGURIA

NO PROBLEM
FLUIDS + FLUIDS ||
NB : 1. * 1 cc / kg BB / jam
2. Oliguria : < 400 cc / m
2
/ hari
41
Fractional
excretion
of Na
+

% 100
plasma urin/Cr. . Cr
plasma urin/Na Na
=
+ +
Renal
Failure
Physiologic
Oliguria
Lasix diuresis (-) diuresis (+)
Laboratorium
Urine osmolality
(mOsm/kgH
2
O)

<350

>500
Na
+
urin (mEq/l) > 40 <20
Fr. excr of Na
+
>1% <1%
42
FEEDING
AFTER REHYDRATION
NO RETURN OR WORSENING
OF DIARRHOEA
TOLERANCE TEST
BREASTMILK
SUB BAGI AN GE BI KA 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
1. Cholera
2. Shigellosis
3. Amoebiasis
4. Giardiasis
Acute Diarrhoea
(WHO)
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)
1. Bowel Movement
2. Stool Consistency
3. Cramps

A drug that can be shown by objective
measurement to treat or control the symptoms
of diarrhea
48
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


Antidiarrheal
NB : Gol 1 s/d 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
50
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
DIARRHOEA
DEHYDRATION
COMPLICATION
REHYDRATION

-RINGERS LACTATE
-RINGERS ACETATE
-ORS
- ELECTROLYTES
IMBALANCE
- METABOLIC ACIDOSIS
- FEVER
- CONVULTION
- HYPOGLICEMIA
ELECTROLYTES - ACID BASE
INITIAL
DIAGNOSIS
REHYDRATION
TREATMENT
ELECTROLYTES ACID BASE
INITIAL
ISONATREMIA
DEHYDRATION
REHYDRATION
HYPONATREMIA
DILUTIONAL
54
DIARRHOEA
METABOLIC ACIDOSIS
ANION GAP
NORMAL
LOSS OF HCO
3
-

INCREASED
STARVATION
RENAL
HYPOPERFUSION
TISSUE HYPOXIA
SALICYLATE
INTOXICATION
INBORN ERROR
55
ANION GAP = Na
+
- (Cl + HCO
3
-
)
NORMAL = 8 16 mEq/L
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.O
2
AFFINITY OF Hb + ANOXIA
8.KUSSMAUL BREATHING HYPO-
CARBIA vasoconstriction Cerebral
Blood Flow ++ drowsiness
57
REHYDRATION
pH , HCO
3
- , pCO
2
pH < 7.2 ATAU HCO
3
- < 10 mEq/L
HCO
3
-
= 1-2 mEq/Kg BB
- LUNG DYSFUNCTION (-)
- HYPOKALEMIA (-)
DEHYDRATION + METABOLIC ACIDOSIS
pCO
2
(calculated) = (1.54 X HCO3-) + 8.36 + 1.11
APPOPRIATE NO APPROPRIATE
METABOLIC ACIDOSIS
58
NO APPROPRIATE
pCO
2
(c) > pCO
2
(lab) pCO
2
(c) < pCO
2
(lab)
METABOLIC ACIDOSIS
+
RESPIRATORY ALKALOSIS
METABOLIC ACIDOSIS
+
RESPIRATORY ACIDOSIS
OVERSHOOT METABOLI C ALKALOSI S PARADOXAL ACIDOSIS
HCO
3
-
59
DOSAGE OF HCO
3
-
( mcg)
HCO
3
-
= (HCO
3
-
desired
- HCO
3
-
actual
) X 0,3 X BB(kg)

HCO
3
-
d

?

HCO
3
-
d

H
2
CO
3
20
HCO
3
-
d
20 x 0,03 pCO
2
= 0,6 pCO
2
..(1)
pCO
2 ( 1,54 X HCO
3
-
a
) + 8,36 1,11 (2)
HCO
3
-
a
pCO
2
- 8,36
1,54
(O.6 pCO
2
- 5)

HCO
3
-
=
= 1,5 m cg/kgBB
= 1 - 2 m cg/kgBB
=
=
=
=
0,6 pCO
2
- (

0,6 pCO
2
- 5) X 0,3 BB(KG)
BICARBONATE
1.SLOW INFUSION TO PREVENT :

=OVERSHOOT METABOLIC ALKALOSIS

=ACIDOSIS INTRACELLULER
2.HYPOKALEMIARESPIRATORY PARALYSIS
3.LUNG DYSFUNTION PARADOXAL ACIDOSIS
4.CIRCULATORY INSUFFICIENCY
61
NaHCO
3

I.V. ADMINISTRATION
SERUM : HCO
3
-
+ H
+


CORRECTION OF
ACIDOSIS
DECREASING
RESPIRATORY
DRIVE
H
2
O + CO
2

BLOOD BRAIN BARRIER
BRAIN : HCO
3
-
+ H
+

SLOW
H
2
O + CO
2

RAPID
CEREBRAL ACIDOSIS
AND DEPRESSION
MECHANISM OF PARADOXAL ACIDOSIS
62
vasodilatation ICP
anoxia
acidosis intracelluler Hypercarbia
63
BICARBONAT

1 mEq/kgBB/X

DILUTES : 5-6 X 1 HOUR

TO PREVENT

INTRACRANIAL OVERSHOOT
BLOOD VESSEL METAB.ALKALOSIS
RUPTURE ACIDOSIS
INTRACELLULARE

REHYDRATION
HYPERNATREMIA
( > 150 mEq/l)
- IVFD STOPPED
- PLAIN WATER
DEHYDRATION + HYPERNATREMIA
REHYDRATION
HYPONATREMIA
( < 135 mEq/L)
Sympt
HypoNa
After
Rehydration
Asympt
HypoNa
NaCl 3%
Fluid Restriction
RL
Na
+
(mEq)
= (135 Na
+
plasma) x 0,6 x BW (kg)
DEHYDRATION + HYPONATREMIA
REHYDRATION
HYPOKALEMIA
Diarrhoea (+) Diarrhoea++
HYPERKALEMIA
Renal Function
ECG RL
N abN
K
+
oral
K
+
drip
(upto 3 mEq / kgBW / day)
Acute Renal Failure
Fluids
Restriction
DEHYDRATION HYPO/ HYPERKALEMIA
FEVER
TEMPERATURE DOWN
COOLING
DRUGS
- Unclothed
- Wipe of sweat
- Fanning
- Tepid sponging
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
69
V. CHOLERAE
O
1

Non O
1
(Non Agglutinable)
- Biotip - Eltor
- Classic

- Serotip - Ogawa
- Inaba
- Hikojima
O
2 - 138
O
140 - 142

O
139

Bengal Strain
ENTEROTOXIN
Absorption of Na
+

in Villous Cells are intact
Surface Receptor
Secretion of Cl
-

in Crypt Cells
Adenyl Cyclase
C - AMP
Villi
Crypt
Bowel Lumen
Absorption
Secretion
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
- CLINIC
CHILDREN > 2 YEARS
SEVERE DEHYDRATION
THE OTHER CHILDREN (+)
- LAB
DARK FIELD MICROSCOPE
CULTURE
DIAGNOSIS
- CLINIC
CHILDREN > 2 YEARS
SEVERE DEHYDRATION
THE OTHER CHILDREN (+)
- LAB
DARK FIELD MICROSCOPE
CULTURE
Th
Water & Electrolytes Ringers
Lactate I.V.





FEEDING
ANTIMICROBIAL Tetracycline or
Doxycycline
Rehydration & Maintenance
Fecal Sodium
( 88 101 mEq/ L)
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
COLON
S. DYSENTERIAE
S. FLEXNERI
S. BOYDII
S. SONNEI
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
82
SALMONELLOSIS
TYPHOIDAL ENTERIC FEVER :
-S. TYPHOID TYPHOID FEVER
-S. PARATYPHOID PARATYPHOID FEVER
NON TYPHOIDAL : SALMONELLA
GASTROENTERITIS
INDICATION OF ANTIMICROBIAL
TREATMENT IN SALMONELLA
GASTROENTERITIS
1. s 3 MONTHS OF AGE
2. OLD DEBILITATED PATIENT
3. DYSENTERY FORM ESPECIALLY
ILLNESS > 5 DAYS
4. IMMUNOCOMPROMISED : STEROID,
MALIGNANCY
5. BACTERIAEMIA

84
ACUTE DIARRHOEA PERSISTENT DIARRHOEA
PROLONGED MUCOSAL INJURY
=MALNUTRITION
=IRON DEFICIENCY
=ANTIBIOTICS
=COWS MILK
=INFECTION
85
PROLONGED MUCOSAL INJURY
MALABSORPTION OF NUTRIENT
PEM
DECREASED
ENTERIC HORMONE
INCREASED ABSORPTION OF
NATIVE FOREIGN PROTEIN
INEFFECTIVE VILLOUS REPAIR
BACTERIAL OVERGROWTH
AND INFECTION
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
x 1OO %
88
X= 10 Kg
Y= 9,25 Kg
10-9,25
10
x 100 %= 7,5 %
Fluid defisit= 10-9,25=0,75 Kg=750 cc
A.
(Some dehydration)
B.
Some dehydration= 7,5 %
BW on admission(Y)=9,25 Kg
X ?

C.
Fact 75 cc/Kg=75 x 9,25= 694 cc
(X-Y)100=7,5 X92,5 X=100YX=100/92,5 X 9,25
=10 Kg

Fluid defisit=10-9,25 = 750 cc