ACUTE

DIARRHEA
PRECEPTOR :
dr. Ulynar Marpaung, Sp.A
BY :
Vilona Afrita Zilmi (1102012302)
Clerkship of Pediatrics Department
Faculty of Medicine YARSI University
Police Hospital, Bhayangkara Tk.I Raden
Said Sukanto

Name
: Child A.A
Birth Date
: March 16th, 2016
Age
: 2 months
Gender
: Male
Religion
: Islam
MR No.
: 8143**
Date of admission : May 05th, 2016
Date of examination
: May 05th, 2016

IDENTIT
Y

Father

Mother

Name

Mr. M

Mrs. M

Age

40 years old

38 years old

Job

Private employees

Housewife

Nationality

Indonesian

Indonesian

Religion

Islam

Islam

Education

High school

Junior High school

Address

Suralaya street No.122 RT.004/04, Cilangkap.

East Jakarta

ANAMNESIS
The anamnesis was taken on May 05th 2016 using
alloanamnesis method. It was taken at room No. 5
Anggrek 2 Ward, RS Bhayangkara tk.I R. Said Sukanto,
Jakarta.
Main complaint
hospital.

: Fever since 6 days prior to admission to

Additional
Additional complaint
complaint :: Watery
Watery stools
stools
10x/day
10x/day since
since 3
3 days
days
before
before admission
admission to
to hospital,
hospital, spray,
spray, dregs
dregs (-),
(-), foam
foam (+),
(+), bad
bad
odor,
odor, blood
blood (-),
(-), the
the color
color is
is yellow.
yellow. Vomiting
Vomiting after
after drinking,
drinking,
frequency
frequency 5x/day,
5x/day, nausea
nausea (+),cold(+)
(+),cold(+)

 A 2 months old
boy with body
weight 5,5 kg
came to RS
Bhayangkara
tk.I R. Said
Sukanto
Emergency
Room at May,
05th 2016 on 2
am with a main
complaint of
fever since 6
days ago.

Since 6 days ago,

the patient has
gotten fever. The
fever high
constantly and
wasnt measured.
His mother gave
sanmol syrup to
decrease the
temperature but
it did not go
down well.

diarrhea since 3
days ago.
frequency
10x/days,
consistency
liquid, no dregs,
foam positive, no
blood, bad odor,
the color is
yellow.
vomiting,
frequency 5x
every after
drinking, yellow
liquid, and spray,
nausea, and cold.

HISTORY
HISTORY OF
OF
ILLNESS
ILLNESS
History of Past Illness
Pharyngitis/Tonsilitis

Bronchitis
Pneumonia

Morbilli

Varicella

Diphteria

Malaria

Polio

Enteritis

Bacillary Dysentry

Amoeba Dysentry

Diarrhea

Thypoid

Worms

Surgery

Brain Concussion

Fracture

Drug Reaction

Febril seizure

ALLERGIC
ALLERGIC
HISTORY
HISTORY
The patient
didnt have
allergy to
medicine
The patient
didnt have
allergy to food
The patient
didnt have
allergy to
weather and
pollen

CHILDS
CHILDS BIRTH
BIRTH
HISTORY
HISTORY

Labor
: Hospital
Birth attendants : Doctor
Mode of delivery : SC
Gestation
:36 weeks
Infant state
:Healthy
Birth weight
: 3500
grams
Body length
: 51 cm

DEVELOPMENT
DEVELOPMENT
HISTORY
HISTORY

Smile
1months

Raised
hand
2 months

Conclution : growth and

developmental is still in the normal
limits and was appropriate according
to the patients age

Childs Eating History

Childs Eating History
Breast milk : Exclusive until now

IMMUNIZATION
HISTORY
Immunizat
Frequency
ion
BCG
Hepatitis
1 time
B
DPT
Polio
Campak
-

Time
0 month
-

FAMILY HISTORY

Patients father
is healthy
Patients
mother is
healthy

There are not any

significant illnesses
or chronic illnesses in
the family declared

PHYSICAL EXAMINATION
-

General condition : Mildly ill

Consciousness
: Compos Mentis
Pulse
: 101 x/min, regular, strong
Breathing rate
: 35 x/min
Temperature
: 38,72C per axilla

ANTHOPOMETRY
STATUS
Weight : 5,5 kg
Height : 60 cm

WFA (Weight for Age) : 5,5/5,2

x 100 % = 105 % (good nutrition)
HFA (Height for Age) : 60/58 x
100 % = 103 % (good noutrition)
WFH (Weight for Height) :
5,5/5,4 x 100 % = 101 % (good
noutrition)

Conclution : The patient

has good noutritional
status.

Head to Toe
Examination
Head
Normocephal, hair (black, normal distribution, not easily
removed), sign of trauma (-), large fontanelle closed,
fontanel concave (+)
Eyes
Icteric sclera -/-, pale conjungtiva -/-, hyperaemia
conjungtiva -/-, Tears +/+ sunken eyes +/+, pupils
3mm/3mm isokor, direct and indirect light response ++/++.
Ears
Normal shape, no wound, no bleeding, secretion or serumen.
Nose
Normal shape, midline septum, secretion +/+.

Mouth
Lips
: dry
Teeth
: no caries
Mucous : dry
Tongue : clean
Tonsils
: T1/T1, no hyperemia
Pharinx : no hyperemia
Neck
Lymph node enlargement (-), scrofuloderma (-).
Thorax
Inspection : Symmetric when breathing, retraction (-), ictus cordis is
not visible, rash (+)
Palpation : Fremitus tactile +/+ symmetric, mass (-)
Percussion : Sonor on both lungs
Auscultation : Cor
: S1-S2 regular, murmur (-), gallop (-)
Pulmo : vesicular +/+, ronchy -/-, wheezing -/-

Abdomen
Inspection : Convex, epigastric retraction (-), spider nevi (-), rash (-)
Palpation : Supple, abdominal mass (-), liver and spleen not
palpable, fluid wave (-)
Percussion : tympanic abdomen on the entire field, shifting dullness
(-), bloated (+), Auscultation : bowel sound increase, bruit (-)
Vertebra
There werent appear scoliosis, kyphosis, lordosis, and any massa
long the vertebral line.
Ekstremities
Warm, capillary refill time <2 second, edema (-)
Skin
Turgor slowly, rash (-), dry skin (+)
Genitalia
Anus Hyperemis (+)

MOTORIC EXAMINATION
NEUROGICAL
EXAMINATION

Meningeal Sign
Nuchal rigidity
(-)
Kernig sign
(-)
Lasegue sign
(-)
Brudzinski I (-)
Brudzinski II (-)

Power
Hand
Feet
Tonus
Hand
Feet
Trophy
Hand
Feet
Physiologic Reflex
Upper extremities
Biceps
Triceps
Lower extremities
Patella
Achilles
Pathologic Reflex
Upper extremities
Hoffman
Trommer
Lower extremities
Babinsky
Chaddock
Oppenheim
Gordon
Schaeffer

5555/5555
5555/5555

Normotonus / Normotonus
Normotonus / Normotonus

Normotrophy / Normotrophy
Normotrophy / Normotrophy

+/+
+/+

+/+
+/+

-/-/
-/-/-/-/-/-

Clonus

AUTONOM
EXAMINATION

Defecation
Urination
Sweating

Diarrhea (frequency 10
times daily)
Normal (4-5 times daily)
Normal

LABORATORY
INVESTIGATION
Hematology (May, 05th, 2016)

Hematology

Results

Normal Value

Hemoglobin

11,9

13 16 g/dl

Leukocytes

18.600

5.000 10.000
u/l

Hematocrits

34

40 48 %

Thrombocytes

605.000

150.000
400.000 /ul

Complete feces (May, 05th 2016)

Macroscopic
Color
Consistency
Mucous
Blood
Microscopic
Leucocytes
Eritrocytes
Worm eggs
Ascaris Sp
Anchilostom
a Sp
Trichuris Sp
Oxyuris Sp
Others

Complete urin (May, 05th, 2016)

Results

Normal
Value

Yellow
Liquid
-

0-1/LPB
2-3/LPB

Color
Purity
Ph
Specific
Weight
Protein
Bilirubin
Glukosa
Keton
Blood/ Hb
Nitrite
Urobilinogen
Leucocytes
Sedimen :
*Leucocytes
*Erythrocyte
s
*Epitel Cell
*Silinder
*Crystal
Others

Results
Yellow
Clear
5.0

Normal Value

5 8.5

1.030

1.000 1.030

0,1

12

Negative
Negative
Negative
Negative
Negative
Negative
0,1 1,0 IU
Negative

0 5 /LPB

02

1 3 /LPB

+
-

/LPK

WORKING DIAGNOSIS
Acute Diarrhea with Mild-Moderate
Dehydration

MANAGEMENT
IVFD RL 600 cc/ 24 hours (32 tpm)
Paracetamol 3x0,6cc per oral
Inj. Cefotaxime 2x300mg
Lacto B 1x1 sachet
Zinkkid 1x10mg

PROGNOSIS

Quo ad vitam

: dubia ad bonam

Quo ad functionam : dubia ad bonam

Quo ad sanactionam

: dubia ad bonam

May, 06th

Follow up
2016, second day of hospitalization, 8th
day of illness

Fever (+)
Defecation (+) frequency 8x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Bloated (+)
Seizure (+), tonik klonik, duration 5 minutes, 1 times/per day

Compos Mentis, Midly ill

Temperature : 39C, Pulse : 101 x/min, Respiratory rate : 32 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (+)

Serology/Imunology (May, 06th 2016)

Kimia clinic (May,06th 2016)

Electrolite

Results

Natrium

121

Kalium

5,0

Chlorida

94

Normal
Value
135-145
mmol/l
3,5-5,0
mmol/l
98-108
mmol/l

Results

Thypi O
Parathypi
AO
Parathypi
BO
Parathypi
CO
Thypi H
Parathypi
AH
Parathypi
BH
Parathypi

+1/80

Normal
Value
Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Negative

Acute Diarrhea with mildmoderate dehydration and

seizure dd KDS
IVFD KAEN 3B 550 cc/24 hours
IVFD NaCl 3% 50 cc in 6 hours
Dummin sup 65mg
Stesolid sup 5mg
Paracetamol 3x0,6cc per oral
Inj. Ceftriaxone 2x300mg
Lacto B 1x1 sachet
Zinkkid 1x10mg

May, 07th

Follow up
2016, third day of hospitalization, 9th day
of illness

Fever (+)
Defecation (+) frequency 5x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Seizure (-)

Compos Mentis, Midly ill

Temperature : 38C, Pulse : 110 x/min, Respiratory rate : 35 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (+)

Hematology (May, 07th 2016)

Hematology
Hemoglobin
Leukocytes

Results
9,1
12,400

Hematocrits
Thrombocytes

25
354.000

Normal Value
13 16 g/dl
5.000 10.000
u/l
40 48 %
150.000
400.000 /ul

Kimia clinic (May, 07th 2016)

Electrolite

Results

Normal Value

Natrium

118

135-145 mmol/l

Kalium

5,1

3,5-5,0 mmol/l

Chlorida

91

98-108 mmol/l

Acute Diarrhea with

mild-moderate
dehydration and
seizure dd KDS
NaCl 3% 50 cc in 6 hours
Loading RL 100 cc
KaEN 3B 550cc/day
PCT drip 4 x 60mg (0,6cc)
Inj. Ceftriaxone 2x300mg
Lacto B 1x1 sachet
Zinkkid 1x10mg

May, 08th

Follow up
2016, fourth day of hospitalization,
10th day of illness

Fever ()
Defecation (+) frequency 5x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Seizure (-)

Compos Mentis, Midly ill

Temperature : 37C, Pulse : 115 x/min, Respiratory rate : 34 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (+)

Kimia Clinic (May, 08th 2016)

Electrolite

Results

Normal Value

Natrium

126

135-145 mmol/l

Kalium

5,0

3,5-5,0 mmol/l

Chlorida

98

98-108 mmol/l

Acute Diarrhea with mildmoderate dehydration and

seizure dd KDS
Hyponatremia
IVFD KaEN 3B 550CC/day
IVFD NaCl 0,9% (31 tpm micro)
PCT drip 4 x 60mg
Lacto B 2x1 sachet
Zinkid 1x10mg

May, 09th

Follow up
2016, fifth day of hospitalization, 11th
day of illness

Fever ()
Defecation (+) frequency 6x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Seizure (-)

Compos Mentis, Midly ill

Temperature : 37C, Pulse : 115 x/min, Respiratory rate : 34 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (+)

Hematology
Hemoglobin
Leukocytes

Results
9,1
10,000

Hematocrits
Thrombocytes

26
493.000

Count of Leukocytes type

Basofil
2
Eosinofil
3
Rod
1
Segmen
52
Limfocytes
26
Monocytes
16
LED
10
Eritrocytes
3,09

Normal Value
13 16 g/dl
5.000 10.000
u/l
40 48 %
150.000
400.000 /ul
0-13 %
1-3 %
2-6 %
50-70%
20-40%
2-8%
<15mm/hour
Milyar/ul

Electrolite

Results

Natrium

121

Kalium

5,6

Normal
Value
135-145
mmol/l
3,5-5,0

Acute Diarrhea with mildmoderate dehydration and

seizure dd KDS
Hyponatremia
IVFD KaEN 3B 600cc/24 hours
IVFD NaCl 0,9% (31 tpm micro)
PCT drip 4 x 60mg
Lacto B 2x1 sachet
Zinkid 1x10mg
Inj. Ceftriaxone 2x300mg

May, 10th

Follow up
2016, sixth day of hospitalization, 12th
day of illness

fever (-)
Defecation (+) frequency 6x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Seizure (+), tonik klonik, fokal, lower extremity dextra, 5minutes per
day

Somnolen (E2M3V2), Moderate ill

Temperature : 36C, Pulse : 156 x/min, Respiratory rate : 45 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (+)

Analysis Blood Gas ( May, 10th 2016 at 07:04)

Test

Results

pH
pCO2
pO2
CO2
Saturation
HCO3
Base Excess

7,26
43
207
99

SBC
Total CO2
SBE

19
20
-7

Electrolite

Results

Natrium

104

Kalium
Chlorida
GDS

8,7
75
293

19
-8

Kimia Clinic (( May, 10th 2016 at 10:13)

Normal
value
7,35-7,45
35-45 mm Hg
85-95mm Hg
85-95%
21-25 mmol/L
-2,5-+2,5
mmol/L
22-26 mmol/L
21-70 mmol/L
-2,4-+2,3
mmol/L
Normal
Value
135-145
mmol/l
3,5-5,0 mmol/l
98-108 mmol/l

Hematology ( May, 10th 2016 at 10:13)

Hematolog
Results
Normal
y
Value
Hemoglobi
8,3
13 16 g/dl
n
Leukocyte
33,700
5.000
s
10.000 u/l
Hematocri
25
40 48 %
ts
Thrombocy
466.000
150.000
tes
400.000 /ul
Count of Leukocytes type
Basofil
0
0-13 %
Eosinofil
1
1-3 %
Rod
10
2-6 %
Segmen
45
50-70%
Limfocytes
14
20-40%
Monocytes
29
2-8%
LED
5
<15mm/hour
Eritrocytes
2,80
Milyar/ul

Kimia Clinic ( May, 10th 2016 at 21:41)

Electrolite

Results

Natrium

126

Kalium

4,2

Normal
Value
135-145
mmol/l
3,5-5,0 mmol/l

Chlorida

98

98-108 mmol/l

Acute diarrhea with severe

dehydration and seizure
Hyponatremia
Hyperkalemia

Inj, Dexamethasone 3x0,5mg

Inj. Ceftriaxone 2x300mg
Candistatin 3x0,5ml
Lacto B 3x1/2 sach
Zinkid 1x10mg
IVFD RL 800cc/day
IVFD NaCl 3% 500cc
O2 3liters/minutes
Pro ICU

May, 11th

Follow up
2016, seventh day of hospitalization,
13th day of illness

Fever (-)
Defecation (+) frequency 4x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Seizure (-)

Somnolen (E2M3V2), Midly ill

Temperature : 36,9C, Pulse : 112 x/min, Respiratory rate : 42 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, dry mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (+)

Acute diarrhea with severe

dehydration
Hyponatremia

Inj, Dexamethasone 3x0,5mg

Inj. Ceftriaxone 2x300mg
Candistatin 3x0,5ml
Lacto B 3x1/2 sach
Zinkid 1x10mg
IVFD RL 800cc/day
IVFD NaCl 3% 500cc
O2 3liters/minutes
Pro ICU

May, 12th

Follow up
2016, eighth day of hospitalization,
14th day of illness

Fever (-)
Defecation (+) frequency 4x, consistency liquid, yellow color, bad odor,
foam(+) dregs (-) no mucous nor blood
Seizure (-)
Child can cry

Composmentis, Midly ill

Temperature : 36,9C, Pulse : 112 x/min, Respiratory rate : 37 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes +/+, tears +/+
Mouth : Dry lips, wet mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (+)
Akral : Warm
Anus
: Hyperemis (-)

Hematology ( May, 12th 2016)

Hematology
Hemoglobin

Results
8,9

Normal Value
13 16 g/dl

Leukocytes

16,600

Hematocrits

23

5.000 10.000
u/l
40 48 %

Thrombocyte
s

442.000

150.000
400.000 /ul

A
P

Acute diarrhea with

improvement
Inj, Dexamethasone
3x0,5mg
Inj. Ceftriaxone 2.300mg
Candistatin 3x0,5ml
Lacto B 3x1/2 sach
Zinkid 1x10mg
IVFD RL 800cc/day

May, 13th

Follow up
2016, nineth day of hospitalization,
15th day of illness

Fever (-)
Defecation (+) frequency 3x, consistency liquid, yellow color, bad odor,
foam(+) dregs (+) no mucous nor blood
Seizure (-)
Child can cry

Composmentis, Midly ill

Temperature : 36,9C, Pulse : 112 x/min, Respiratory rate : 37 x/min
Head :Normocephal, fontanel concave (+)
Eyes
: Pale conjungtiva (-), icteric sklera (-), hyperemia conjungtiva (-),
sunken eyes -/-, tears +/+
Mouth : Dry lips, wet mucous, tonsils T1/T1,hyperemia pharinx
Pulmonary : Vesiculer +/+, ronchi -/-, wheezing -/Cardio : S1/S2 normal regular, murmur (-), gallop (-)
Abdomen : Distention (+), bowel sound (+) increase, bloated (+)
Skin
: dry (+), Turgor Slowly (-)
Akral : Warm
Anus
: Hyperemis (-)

A
P

Acute diarrhea with

improvement
Inj, Dexamethasone
3x0,5mg
Inj. Ceftriaxone 2.300mg
Candistatin 3x0,5ml
Lacto B 3x1/2 sach
Zinkid 1x10mg
IVFD RL 800cc/day

Hematology ( May, 13th 2016)

Hematology

Results

Normal Value

Hemoglobin

12

13 16 g/dl

Leukocytes

10,600

Hematocrits

41

5.000 10.000
u/l
40 48 %

Thrombocytes

442.000

150.000
400.000 /ul

Kimia Clinic ( May, 13th 2016)

Electrolite

Results

Normal Value

Natrium

136

135-145 mmol/l

Kalium

5,0

3,5-5,0 mmol/l

Chlorida

104

98-108 mmol/l

SECTION II
LITERATUR
E REVIEW

DEFINITION
Diarrhea is the passage of loose or watery
stools at least 3 times in a 24- hour
period. However, it is the consistency of
the stools rather than the number that is
most important. Acute diarrhea may be
caused by different viruses, bacteria, and
parasites

EPIDEMIOLO
GY

CLINICAL
MANIFESTATION

DIAGNOSIS
should be asked the following matters: a long diarrhea, frequency, volume, fecal consistency, color,
odor, presence or absence of mucus and blood.
Frequency of urination, volume and frequency of vomitting, food and drinks were given, Is there any heat
Anamnesis or other accompanying diseases, other actions that have been carried out during diarrhea.

On physical examination need to be examined: weight, body temperature, heart rate and respiration
and blood pressure.
Physical Further need to find the main signs of dehydration: awareness, thirst and skin turgor abdomen and
examinatio signs of other extras: fontanel concave or not, the eyes: cowong or not, the presence or absence of tears,
lips, oral mucosa and tongue dry or wet.

Laboratori
um

Detailed laboratory examination in acute diarrhea is generally not required, only in certain
circumstances may be required, for example the underlying cause is unknown or there are other
causes other than acute diarrhea in patients with severe dehydration.
Microscopic examination for the presence of leukocytes can provide information about the cause of
diarrhea, anatomical location and the presence of mucosal inflammation process.

THERAPY
Ministry of Health identified five pillars of the management of diarrhea in all
cases of diarrhea that affects children under five treated both at home and
was hospitalized, namely:
1.Rehydrate by using the new ORS
2.Zinc is given for 10 consecutive days
3.Breast milk and food to be continued
4.Antibiotics selective
5.Advice to parents
Recommendations for inpatient hospital based on consensus and is followed
by the following conditions:
6.Shock
7.Dehydration weight (> 9% weight)
8.Neurological abnormalities (lethargy, convulsions)
9.Intractable, bilious vomiting
10.Kegalalan oral rehydration
11.Allegedly abnormality surgery
12.Conditions for safe follow-up and management can not be done at
home

Seizure with electrolyte

imbalance

Seizures occurring in patients with sodium disorders, hypocalcemia,

and hypomagnesemia, are usually generalized tonic-clonic, but also
focal (partial) seizures or other seizure types may be present. Rapidly
evolving electrolyte disturbances are more likely to cause seizures
than those developing more gradually

TREATMENT
The most common treatment for
hyponatremia consists of hypertonic
saline (3%), which produces a rapid
reduction in brain volume and
intracranial pressure. An increase in
serum sodium to values of 120 mEq/L
to 125 mEq/L should be the target of
therapy

CONCLUSSION

Diarrhea is the passage of loose or watery stools at least 3

times in a 24 hour period. However, it is the consistency of
the stools rather than the number that is most important.
Acute diarrhea may be caused by different viruses, bacteria,
and parasites. It is most practical to base the treatment of
diarrhea on the clinical type of the illness, which is easy to
establish when a child is first examined. Usually there is no
need for laboratory tests.
One of complication of diarrhea is seizure. Seizures
represent an important clinical manifestation of electrolyte
disorders and are more frequently observed in patients with
hyponatremia, hypocalcemia, and hypomagnesemia