simpo 2 - diarrhea, vomiting, dehydration and electrolyte imbalance in pediatric patients - dr nenny...
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dr. Nenny Sri Mulyani, Sp.A(K)
Diarrhea, Vomiting, Dehydration and Electrolyte Imbalancein Pediatric Patients
Pediatric Department|Sardjito Hospital|Faculty of Medicine, Universitas Gadjah Mada
Simposium 2
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Alur Presentasi
1. Gastroenteritis Akut
2. Derajat Dehidrasi dan Rehidrasi
3. Special Issue
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GASTROENTERITIS AKUT
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Definisi
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Etiologi
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Manifestasi Klinis Gastroenteritis Akut
• Anoreksia, mual
• Muntah
• Diare
• Dehidrasi dan Imbalans Elektrolit
• Asidosis
• Hipokalemia
• Manifestasi berkaitan dengan CNS
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
![Page 8: Simpo 2 - Diarrhea, Vomiting, Dehydration and Electrolyte Imbalance in Pediatric Patients - Dr Nenny SpA](https://reader038.vdocument.in/reader038/viewer/2022102800/55cf91b5550346f57b8fdf96/html5/thumbnails/8.jpg)
DERAJAT DEHIDRASI
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Plan C
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Plan C dengan Kesulitan Pemasangan Jalur IV
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Plan B
• Dalam 3 jam, berikan 75 ml/kgBB oralit per oral
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Plan A
Berikan :
< 2 tahun : 50-100 ml setiap kali BAB
≥ 2 tahun 100-200 ml setiap kali BAB
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Manajemen Berikutnya setelah Dehidrasi Teratasi
• Zinc
• Probiotik
• Antimikroba
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Special Issue
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Kajian Eksploratif terhadap Pemberian Cairan Intravena pada Tatalaksana Diare Akut pada Anak
(Atuzzaqiyah, 2014 - unpublished)
• Pada intinya, hasil yang didapat :
Rehidrasi pada dehidrasi tidak berat di lapangan dilakukan dengan jalur IV, bukan oral, serta pasien dihospitalisasi
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Dilatarbelakangi dari penelitian tersebut dan pengamatan lapangan, saya menganalisis
beberapa kemungkinan kendala dalam pelaksanaan Plan B
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Kendala dalam Pelaksanaan Plan B(dehidrasi ringan- sedang/some dehydration)
Sosial
• Kekhawatiran orang tua
• Rumah jauh
•Awareness orang tua maupun pengasuh dinilai dokter kurang
Klinis Pasien
•Malas minum karena mual, bukan karena kesadaran menurun
•Muntah setiap kali minum
• Rentan menjadi dehidrasi berat karena on going loss tinggi
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Kendala dalam Pelaksanaan Plan B( dehidrasi ringan- sedang/some dehydration)
Fasilitas
• Tidak ada ruang rehidrasi oral
Petugas Medis
• Dokter ragu dalam membedakan dehidrasi ringan-sedang dan berat dengan Standard Nasional (ref: WHO)
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Solusi
Mencari evidence-based dari referensi lain:
• ESPGHAN and ESPID : Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe. 2008.
• Gastroenteritis in Children. American Academy of Family Physician. 2012
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Kendala Pertama
Sosial
• Kekhawatiran orang tua
• Rumah jauh
•Awareness orang tua maupun pengasuh dinilai dokter kurang
Fasilitas
• Tidak ada ruang rehidrasi oral
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Dengan catatan :
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Kendala Kedua
Petugas Medis
• Dokter ragu dalam membedakan dehidrasi ringan-sedang dan berat
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Kendala Ketiga
Klinis Pasien
•Malas minum karena mual, bukan karena kesadaran menurun
•Muntah setiap kali minum
• Rentan menjadi dehidrasi berat karena on going loss tinggi
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Menurut Nasional/WHO
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Ondansetron
• Diperbolehkan, tetapi tidak rutin diberikan
• Diberikan di IRD
• Keuntungan :– secara signifikan mengurangi muntah segera setelah
pemberian
– menurunkan kemungkinan diperlukannya rehidrasi jalur IV
– menurunkan kemungkinan rawat inap
• Anti muntah lain tidak dianjurkan karena belum ada bukti yang mendukung
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Antimolititas : Loperamide
• TIDAK boleh digunakan pada diare anak sekalipun dapat mengurangi on going loss
• Efikasi ada, tetapi adverse event serius banyak dilaporkan, antara lain ileus, letargi, meninggal
• Risiko adverse event > benefit
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Take-Home Message!
• Dehidrasi pada gastroenteritis akut menjadi masalah utama pada pasien anak
• Klinisi di pelayanan primer, instalasi atau unit gawat darurat, dan rumah sakit harus menilai derajat dehidrasi pada saat menerima pasien dengan gastroeneteritis akut
• Penting diketahui kajian-kajian yang berhubungan dengan kesulitan-kesulitan di lapangan
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Terima Kasih