DIARRHOEA

(2)

ANTIMICROBIAL
Acute Diarrhoea
(WHO)

1. Cholera
2. Shigellosis
3. Amoebiasis
4. Giardiasis

ANTIMICROBIAL (WHO,2005)
1.

CHOLERA

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

3 days

2.

SHIGELLA DYSENTERY

3.

CIPROFLOXACIN 15 mg/KgBW/x- 2 x a day

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
ANTIMICROBIAL :
-Streptomycin
-Neomycin
-Hydroxyquinolin
-Unabsorbed Sulfa
2. ANTIMOTILITY :
-- Loperamide
-- Diphenoxylate

3. ADSORBENT :
-Kaolin/pectin
-Charcoal
-Atapulgit / smectite
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
REHYDRATION
-RINGERS LACTATE
-RINGERS ACETATE
-ORS

COMPLICATION
- ELECTROLYTES
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
PROLIFERATION,TOKSIN PRODUCTION &
INVASIVE BY MICROORGANISMS
5. GUT PARALYSIS

ELECTROLYTES - ACID BASE

INITIAL

DIAGNOSIS

REHYDRATION

TREATMENT

ELECTROLYTES ACID BASE

INITIAL

ISONATREMIA
DEHYDRATION

REHYDRATION

HYPONATREMIA

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
HypoNa

Sympt
HypoNa

After
Rehydration

RL

NaCl 3%

Fluid Restriction

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

DEHYDRATION HYPO/ HYPERKALEMIA

REHYDRATION
HYPERKALEMIA
HYPOKALEMIA
Renal Function
Diarrhoea (+)

Diarrhoea

RL

Acute Renal Failure

ECG
N

Abnormal

K+ oral

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

Fluids
Restriction

FEVER
TEMPERATURE DOWN
COOLING
- Unclothed
- Wipe of sweat
- Fanning
- Tepid sponging

DRUGS
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
C - AMP
Secretion of Clin Crypt Cells

Absorption

Villi

Bowel Lumen

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
- 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

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

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?