Kejang Demam
Meningitis
Pathophysiology : Bacteria gain entry to the CSF through the choroid plexus of the lateral
ventricles and the meninges and then circulate to the extracerebral CSF and subarachnoid space.
Bacteria rapidly multiply because the CSF concentrations of complement and antibody are
inadequate to contain bacterial proliferation
Therapy:
-Antibiotic
- Corticosteroid : intravenous dexamethasone, 0.15 mg/kg/dose given every 6 hr for 2 days,
Rheumatic Fever
Therapy:
-
Bed rest
Aspirin
Prednisolone
Benzylpenicilline (25mg/kg IM or IV)
Sydenhams chorea : prednisolone (2 mg/kg/day) 4 weeks; then taper.
Encephalitis
HSV Encephalitis : intravenous acyclovir (10 mg/kg every 8 hr given over a 1 hr infusion for
1421 days). Treatment for increased intracranial pressure, management of seizures, and
respiratory compromise may be required. (Nelson 18th edition)
Bronkopneumonia
Pathogenesis:
Viral pneumonia results from spread of infection along the airways, accompanied by direct
injury of the respiratory epithelium, resulting in airway obstruction from swelling, abnormal
secretions, and cellular debris. The small caliber of airways in young infants makes them
particularly susceptible to severe infection. Atelectasis, interstitial edema, and ventilationperfusion mismatch causing significant hypoxemia often accompany airway obstruction.
Bacterial infection is established in the lung parenchyma, the pathologic process varies
according to the invading organism. M. pneumoniae attaches to the respiratory epithelium,
inhibits ciliary action, and leads to cellular destruction and an inflammatory response in the
submucosa. As the infection progresses, sloughed cellular debris, inflammatory cells, and mucus
cause airway obstruction, with spread of infection occurring along the bronchial tree, as it does
in viral pneumonia.
Therapy:
-
Diare
Diare akut
Diare Kronik
Sindroma Nefrotik
-
Severe symptomatic edema, including large pleural effusions, ascites, or severe genital
edema, should be hospitalized
when fluid restriction and parenteral diuretics are not effective IV administration of
25% human albumin (0.5 g/kg/dose q 612 hr administered over 12 hr) followed by
furosemide (12 mg/kg/dose IV)
Konstipasi
Tatalaksana: (Pedoman Pelayanan Medis Anak IDAI)
-
Demam Tifoid
Tata laksana :
(Pedoman Pelayanan Medis IDAI)
Antibiotik
Kloramfenikol (drug of choice) 50-100 mg/kgbb/hari, oral atau IV, dibagi dalam 4 dosis
selama 10-14 hari
Amoxicillin 100 mg/kgbb/hari, oral atau intravena selama 10 hari
Cotrimoxazole 6 mg/kgbb/hari, oral selama 10 hari
Ceftriaxone 80 mg/kgbb/hari, oral selama 10 hari
Cefixime 10mg/kgbb/hari, oral dibagi dalam 2 dosis selama 10 hari
-Kortikosteroid diberikan pada kasus berat dengan gangguan kesadaa: dexametason 1-3
mg/kgbb/hari intravena, dibagi 3 dosis hingga kesadaran membaik
(Nelson 18th)
-
A soft, easily digestible diet should be continued unless the patient has abdominal
distention or ileus.
Antibiotic therapy is critical to minimize complications
Berikan anak banyak minum larutan oralit atau jus buah, air tajin, air sirup, susu, untuk
Pantau tanda vital dan diuresis setiap jam, serta periksa laboratorium (hematokrit,
trombosit, leukosit dan hemoglobin) tiap 6 jam
Apabila terjadi penurunan hematokrit dan klinis membaik, turunkan jumlah cairan secara
bertahap sampai keadaan stabil. Cairan intravena biasanya hanya memerlukan waktu 24
Berikan oksigen 2-4L/menit secara nasal. Berikan 20 ml/kg larutan kristaloid seperti
(maksimal
pemberian koloid
10-
dan secara bertahap diturunkan tiap 4-6 jam sesuai kondisi klinis dan laboratorium.
Dalam banyak kasus, cairan intravena dapat dihentikan setelah 36-48 jam.
Bronkiolitis
Nebulized salbutamol (0,15mg/kg) 15 menit kemudian Dexametason 0,6 mg/kg IM
Asma
Step 1: Occasional -agonist via pMDI. If needed >~ 3x/week, add step 2 (also if >5 year and
many exacerbations, or asthma wakes from sleep > once/week)
Step 2 : Add inhaled steroid, eg: beclometasone: specifity brand. As potencies vary : Clenil
Modulite 50g is a lover-potency CFC-free inhaler, Qyar 50 g (CFC free) is high potency. Use
up to 200g of Clenile/12h
Step 3 : Review diagnosis; check inhaler use/concordane; eliminate triggers, monitor height. If
< 5 yrs Add 1 evening doses montelukast 4mg as a mouth-dissolving capsule. If > 5 yrs: Add
inhaled salmeterol 50/12h (long acting agonist); monitor closely; stop if no help. If
symptomatic inhaled steroid and try montelukast 5mg or theofilin, eg SloPhyllin 125-250
mg/12h PO if 6-12 years.
Step 4 : Refer to specialist (CXR), inhaled steroid (Clinile 400g/12h)
Step 5: Add prednisolone (if > 5 yrs) at lowest dose that work
Dose example : agonists : Salbutamol 100 g via pMID as needed, with spacer.
Anti muscarinic : Ipratropium 20g/8h by aerosol if ~ 6 yrs old; 40g/8h if older
Treating severe asthma : give these treatment if the above life threatening signs are present, or if
not improving 15-30 min after Px starts.
(Nelson 18th)