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IV Fluid Therapy (Children), DIARE [keluar tinja cair >3x dalam 24…
IV Fluid Therapy (Children)
Maintenance Fluid
NPO (nil per oral) Patient
fluid options
;
Children (>28 days y.o)
Crystalloid isotonic fluid + 5% glucose
e.g. D5NS, D5RL
Calculation of Daily Fluid Requirements:
Holliday-Segar Formula
- For the first 10 kg of body weight: → 100 mL/kg/day - For the next 10 kg (i.e., 10–20 kg): → 50 mL/kg/day - For each kg over 20 kg: → 20 mL/kg/day
Neonatus (<28 days y.o)
Without severe disease → D10%
With severe disease → consult to pediatric specialist (Sp.A)
Lahir - hari 1: 50 - 60 ml/ kg/ hari
Hari 2: 70 - 80 ml/ kg/ hari
Hari 3: 80 - 100 ml/ kg/ hari
Hari 4: 100 - 120 ml/ kg/ hari
Hari 5 - 28: 120 - 150 ml/ kg/ hari
Replacement Fluid
Bila pasien terdapat defisit cairan:
Intake oral buruk, muntuh, diare, demam, keringat berlebih, diabetic ketoacidosis, combustio
Fluid options:
Kristaloid isotonik + glucose
e.g. D5% + NS
Vomiting/ diarrhea -> use fluid that consist of kalium suplementation
e.g. KAEN 3B (children) or KAEN 3A (baby)
Dont use RL (metabolism in hepar) in DHF, use RA (metabolism in muscle)
Dehydration percentation severity
By Weight
(Normal weight - weight before sick)/ normal weight x 100%
By Clinical
Dehydration, shock (-): 5 %
Dehydration, shock (+): 10%
Calculate water deficit & total water requirement
Water deficit = % dehydration + BB + 10
Total water requirement = water deficit + maintenance
Resuscitation
Bila pasien dalam kondisi syok
Penurunan kesadaran, kulit pucat/ mottling, akral dingin, takikardia, takipnea, nadi ekstremitas lemah, CRT >2, hipotensi
Fluid option: NaCl 0,9% - Bolus 10 ml/ kg in <10 mins
Less dose use in patients: neonatus (<28 days), DKA, septoc shock, trauma, gangguan jantung (gagal jantung)
Hitung total kebutuhan cairan - koreksi defisit + maintenance
DIARE
[keluar tinja cair >3x dalam 24 jam]
Acute Diarrhea
Akut, berlangsung 3 - 5 hari atau <7 hari
Etiology
Infeksi
Enteral
Bakteri (almonella,shigella, e.coli)
Virus (rotavirus, adenovirus),
Parasit/ protozoa (entamoeba hystolitica),
Jamur
Parenteral
ISPA, ISK, OMA
Non-Infeksi
Intoksikasi makanan, lactose intolerance
Patophysiology and Patogenesis
Imbalance water and electrolyte uptake (change in absorption and secretion of water and electrolyte):
Increase secretion
Osmotic pressure (karena bahan dalam lumen usus)
Motilitas usus meningkat
Gejala Klinis
BAB: frekuensi bertambah, konsistensi berubah (cair, lendir, darah)
Gejala lain: panas, anoreksia, muntah, kembung
Gejala komplikasi: gg elektrolit, dehidrasi, gg gas darah
Cara Pemeriksaan:
Etiologis
Klinis (sulit dibedakan)
Kultur feses (etiologi pasti)
Derajat Dehidrasi
Gangguan elektrolit
Pemeriksaan serum elektrolit: hipernatremia, hiponatremia, hipokalemia
Gangguan gas darah
Pemeriksaan gas darah
Komplikasi
Awal
:
Gg keseimbangan cairan, elektrolit, asam basa
Intoleransi klinik akut terhadap karbohidrat dan lemak
Lambat
diare berkepanjangan (prolonged)
intoleransi klinis terhadap hidrat arang yg berkepanjangan
Diare persisten
Diare kronis
Sindrom post enteritis, diare intraktabel
Fever
