PROBLEM BASED

LEARNING
APPLIED
PHARMACOTHERAPY
Kiki Nur Indah Hardiyanti (1607062058)
Lailla Affiyanti Fauzi
Rahmi Fauziah
DIARRHEA
(1607062065)
(1607062090)
Evin Suci Mardani (1607062101)
Suci Ludpyana Borneo (1607062104)
Tengku Nur Indah Sari (1607062106)
Nurul Puspitasari (1607062131)
Winda Dwi Astuti (1607062153)
Bayu Prio Septiantoro (1607062054)
 CASE 3
Mrs. FR (28 years old) came to drugstore to get a diarrhea medication

for her baby; FR (1 year old). FR experienced diarrhea 6 times since

last night. Feces out in liquid, no blood and mucus found. One day

ago FR was given formulated milk by his mother because of less

amount of breast feeding. FR is having fever (t=38,3C), crying and

thristy but rejecting breast milk. His weight before diarrhea was 9 kg

and now become to 8,3 kg.

 Possibility of disease : Acute
gastroenteritis
Acute gastroenteritis is
generally defined as a
decrease in the Gastroenteritis is a Rotavirus is the
consistency of stools major reason for
(loose or liquid) and/or hospitalization in most frequent
an increase in the children < 3 years. agent of AGE.
frequecy of evacuations
(3 in 24 hours)
Fever, severe
dehydration, and Predominant breast-
lethargy, which are more feeding may reduce
common in rotavirus
infection, indicate the risk of AGE in
systemic involvement young European
and are associated with infants
severe diarrhea.
European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric
Infectious Diseases Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in
Europe: Update 2014
Alfredo Guarino (Coordinator), yShai Ashkenazi, zDominique Gendrel, Andrea Lo Vecchio, yRaanan Shamir, and Hania
 Pathofisiology
Secretory, results from
Osmotic, results from the
substances (eg, bacterial
presence of nonabsorbable
toxins) that increase secretion
solutes in the GI tract, as with
of chloride ions and water into
lactose intolerance
the intestinal lumen

Malabsorptive, short bowel Inflammatory, the resultant

syndrome and conditions that outpouring of plasma, serum
speed up transit time cause proteins, blood, and mucous
diarrhea due to decreased increases fecal bulk and fluid
absorption content
 Rotavirus Pathofisiology of case
infection stimulate the enteric
nervous system indirectly to
increase Cl -secretion

The NSP4
induced increase
Intracellular in Ca 2+ levels
NSP4 (iNSP4)
induces
 Rotavirus (Guarino, 2014)
Parasit (Ascaris lumbricoides) (Tinuade, 2006)
Etiology of case Early cessation of breastfeeding (Tinuade,
2006)

Younger age (Grace, 2010)

Bottle feeding (Tinuade, 2006)
Risk Factor of case Food intake (Tinuade, 2006)
Socio-economic status (Tinuade, 2006)
 Pharmacotherapy
1. IV Ringer Lactate

RL (Sodium-130 mmol/L, chloride-109 mmol/L, lactate-28 mmol/L,

potassium-4 mmol/L, calcium-1.5 mmol/L) in doses of 100 mL/kg
over three or six hours. Fluid correction over three hours.

2. Zinc (Zinc syr)

Once daily 10 mg before night sleep amoung to 10 days (1x1 cth)

3. Probiotic (lacto B)

3 sachet/day

4. Acetaminophen (sanmol drop)

100 mg/ml 3-4/day 1,2 ml

 REFERENCES

World Health Organization.

The Treatment of diarrhoea : a manual for physicians and other senior health
workers. 4th rev.