DIARRHOEA

( 2 )( 2 )

ANTIMICROBIAL

Acute Diarrhoea

(WHO)

1. Cholera

2. Shigellosis

3. Amoebiasis

4. Giardiasis

ANTIMICROBIAL (WHO)

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

3 days

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

5 days5 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

SIDE EFFECT OF ANTIMICROBIAL

1. CHANGING OF INTESTINAL FLORA

2. OVERGROWTH:

- MONILIA

- ENTEROCOCCUS

- ANAEROB- 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

1. Bowel Movement

2. Stool Consistency

3. Cramps

of diarrhoea

1.UNABSORBED

ANTIMICROBIAL :

-Streptomycin

-Neomycin

-Hydroxyquinolin

-Unabsorbed Sulfa

3. ADSORBENT :

-Kaolin/pectin

-Charcoal

-Atapulgit / smectite

4. ANTISECRETORY :

Antidiarrhoeal

-Unabsorbed Sulfa

2. ANTIMOTILITY :

-- Loperamide

-- Diphenoxylate

4. ANTISECRETORY :

-Salicylate Acid

-Chlorpromazine

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)

DIARRHOEA

DEHYDRATION COMPLICATION

REHYDRATION - ELECTROLYTES

IMBALANCE

-RINGER’S LACTATE

-RINGER’S ACETATE

-ORS

IMBALANCE

- ACIDOSIS METABOLIC

- FEVER

- CONVULTION

- HYPOGLICEMIA

OPIATES & SPASMOLYTICA

1. INCREASE THE DURATION OF FEVER

2. PROLONG PASSAGE OF PATHOGENS

3. DECREASE OF BOWEL PERISTALSIS

4. INCREASE THE DURATION OF 4. INCREASE THE DURATION OF

PROLIFERATION,TOKSIN PRODUCTION &

INVASIVE BY MICROORGANISMS

5. GUT PARALYSIS

ELECTROLYTES - ACID BASE

INITIAL REHYDRATION

DIAGNOSIS TREATMENT

ELECTROLYTES – ACID BASE

INITIAL

ISONATREMIA

DEHYDRATION

REHYDRATION

HYPONATREMIA

DEHYDRATION

DILUTIONAL

REHYDRATION

ACIDOSIS METABOLIC

DEHYDRATION + ACIDOSIS METABOLIC

pH < 7.2

HCO3- = 1-2 mEq/Kg BW

- LUNGS DYSFUNCTION (-)

- HYPOKALEMIA (-)

REHYDRATION

HYPERNATREMIA

DEHYDRATION + HYPERNATREMIA

HYPERNATREMIA

( > 150 mEq/l)

- IVFD STOPPED

- PLAIN WATER

REHYDRATION

HYPONATREMIA

( < 135 mEq/L)

DEHYDRATION + HYPONATREMIA

Sympt

HypoNa

After

Rehydration

Asympt

HypoNa

NaCl 3% Fluid RestrictionRL

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

REHYDRATION

HYPOKALEMIA

Diarrhoea (+) Diarrhoea↓↓

HYPERKALEMIA

Renal Function

DEHYDRATION HYPO/ HYPERKALEMIA

Diarrhoea (+) Diarrhoea↓↓

ECGRL

N abN

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

Acute Renal Failure

Fluids

Restriction

FEVER

TEMPERATURE DOWN

COOLING DRUGS

- Unclothed- 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

V. CHOLERAE

O1 Non O1

(Non Agglutinable)- Biotype - Eltor

- Classic

- Serotype - Ogawa

- Inaba

- Hikojima O2 - 138

O140 - 142

O139

“Bengal Strain”

ENTEROTOXIN

Absorption of Na+

in Villous Cells are intact

Surface Receptor

Adenyl Cyclase

Secretion of Cl-

in Crypt Cells

C - AMP

VilliBowel Lumen

Absorption

Secretion

Crypt

Secretion

V. CHOLERAE

JEJUNUM

- COPIOUS DIARRHOEA

- FISHY RICE WATER STOOLS- 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

Th Water & Electrolytes → Ringer’s

Lactate I.V.

Rehydration & Maintenance

Fecal Sodium

( 88 – 101 mEq/ L)

FEEDING

ANTIMICROBIAL → Tetracycline or

Doxycycline

( 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

S. DYSENTERIAE

S. FLEXNERI

COLON

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- URGENCY SYNDROME

- TOXIC MEGA COLON

- RECTAL PROLAPS

Th

1. WATER & ELECTROLYTES

2. FEEDING

3. - SELF LIMITED

- SEVERE • TMP - SMX- 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

1. ≤≤≤≤ 3 MONTHS OF AGE

2. OLD DEBILITATED PATIENT

3. DYSENTERY FORM ESPECIALLY 3. DYSENTERY FORM ESPECIALLY

ILLNESS > 5 DAYS

4. IMMUNOCOMPROMISED : STEROID,

MALIGNANCY

5. BACTERIAEMIA

Infant 10 months of age, was admitted to hospital with Infant 10 months of age, was admitted to hospital with

diarrhoeadiarrhoea. .

On examination On examination : : BW = 8 kg; BW = 8 kg; infant well & alert; infant well & alert;

eyes : eyes : sunkensunken ; drinks eagerly; skin pinch goes ; drinks eagerly; skin pinch goes

back:quicklyback:quickly..

Question : Question :

Exercise :

Question : Question :

1.1.Dehydration………..Dehydration………..

2.2.Amount of fluids will be given………Amount of fluids will be given………

3.3.If the baby aren’t able to drink, what kind of If the baby aren’t able to drink, what kind of

intervention is needed? intervention is needed?

44.If the baby is drinks normally, what type of .If the baby is drinks normally, what type of

dehydration?dehydration?