Liza

Minggu lalu adek dan abang Muntaber. Wah...sedih sekali, sekali 2 sakit barengan. Muntah yang ga berhenti, buang aer juga gitu. Hingga akhirnya dehidrasi.

Mulanya adek lalu abang, nyusul lagi sepupu mereka lalu umi. Bertiga dirawat di rumkit. Migrasi deh dari rumah ke Rumkit. Alhamdulillah umi ga dirawat, hanya diare. Sekali minum obat langsung tokcer.

Berikut saya share artikel mengenai Diare, Muntah dan Dehidrasi yang saya ambil dari makalah Pesat Batam lalu. Semoga bermanfaat

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Diare, Muntah, dan Dehidrasi
 

Diare
 

Diare merupakan gangguan pencernaan yang sering dialami oleh semua orang, termasuk anak-anak. Namun pada anak-anak, diare dapat menjadi keadaan yang mengancam jiwa karena  mereka lebih rentan mengalami dehidrasi dibandingkan orang dewasa. Selain itu diare juga merupakan penyebab utama terjadinya malanutrisi pada anak-anak.

Keadaan-keadaan yang menjadi penyebab utama terjadinya diare adalah higiene yang buruk, sumber air yang tidak bersih dan sehat, lingkungan tempat tinggal yang padat, dan kecenderungan orang tua untuk memberikan susu formula daripada ASI. Padahal anak yang mendapat ASI eksklusif jarang menderita diare.

Diare adalah gangguan usus yang ditandai dengan abnormalitas kandungan air dan konsistensi feses yang dikeluarkan. Diare juga berarti buang air besar dengan feses yang cair, minimal 3 kali dalam 24 jam. Diare dapat disebabkan infeksi oleh mikroorganisme seperti virus, bakteri, ataupun parasit. Penyebab lainnya adalah konsumsi obat-obatan, terutama antibiotika, dan pemakaian pemanis buatan.

Diare biasanya akan berlangsung dalam 1 minggu (3 sampai 6 hari) dan kemudian akan sembuh dengan sendirinya. Diare kronis berlangsung lebih lama dari diare akut, dan biasanya merupakan petanda terdapat gangguan kesehatan yang lebih serius seperti infeksi kronis, gangguan absorpsi makanan/nutrien (malaabsorpsi) ataupun disebabkan oleh penyakit yang disebut sebagai Irritable Bowel Syndrome.

Untuk kemudahan tata laksana, secara klinis diare dibagi menjadi 4 tipe. Pembagian tersebut dengan mudah dapat dilakukan pada saat melakukan pemeriksaan fisis dan tidak diperlukan pemerksaan laboratorium. Selain itu tiap tipe diare merefleksikan proses patologi dan perubahan fisiologis yang terjadi. Empat tipe tersebuat adalah:

1.     Diare Berair Akut

Termasuk dalam kelompok ini adalah kolera. Berlangsung selama beberapa jam hingga beberapa hari. Dapat menyebabkan dehidrasi dan penurunan berat badan.

2.     Diare Berdarah Akut

Selain menyebabkan dehidrasi, juga menyebabkan kerusakan usus, sepsis, dan malanutrisi.

3.     Diare Persisten

Berlangsung selama 14 hari atau lebih. Selain dehidrasi, dapat juga terjadi malanutrisi dan infeksi non-usus.

4.     Diare Dengan Malanutrisi Berat (marasmus dan kwashiorkor)

Selain dehidrasi, keadaan ini dapat menyebabkan infeksi sitemik yang berat, gagal jantung, serta defisiensi mineral dan vitamin.
 

Tata laksana setiap tipe diare terutama bertujuan untuk mencegah dan mengatasi komplikasi-komplikasi yang dapat terjadi

 
Diare yang disebabkan oleh infeksi biasanya ditandai dengan gejala awal berupa demam dan muntah, setelah itu baru timbul diare. Biasanya anak akan merasa “tidak nyaman” tapi tidak merasa sakit. Infeksi oleh bakteri ataupun parasit biasanya menyebabkan fesesnya bercampur darah.

Penyebab Diare
 
Penyebab paling sering diare antara lain:

Virus.

Penyebab paling sering pada anak adalah Rotavirus dan Adenovirus. Biasanya tertular akibat kontak langsung. Misalnya tangan kita menyentuh anak yang sedang sakit diare, lalu tanpa mencuci tangan kita memegang makanan atau minuman, sehingga makanan atau minuman tersebut telah mengandung virus yang jika termakan dapat menimbulkan penyakit.

Bakteri.

Penyebab paling sering antara lain Campylobacter, Salmonella, Shigella, dan Escherichia coli. Biasanya tertular dari makanan ataupun minuman yang terkontaminasi bakteri.  Beberapa bakteri menghasilkan zat toksin yang menyebabkan sel usus halus memproduksi cairan melebihi kemampuan usus besar untuk menyerap cairan, keadaaan tersebut yang menyebabkan terjadinya diare.

 
Parasit.

Antara lain Giardia lamblia dan Cryptosporidium. Biasanya tertular dari makanan ataupun minuman yang terkontaminasi  parasit.
 

Laktosa, salah satu jenis gula yang terdapat dalam susu atupun produk yang terbuat dari susu juga dapat menyebabkan diare pada beberapa orang (Intoleransi laktosa).

 
Diare juga dapat terjadi akibat efek samping obat-obatan yang dikonsumsi, terutama antibiotika. Penggunaan antibiotika yang tidak rasional (misalnya pemberian antibiotika pada infeksi virus) justru dapat mematikan kuman “baik” yang terdapat di dalam usus yang berfungsi dalam proses pencernaan dan menyebabkan suatu keadaan yang disebut sebagai Kolitis Pseudomembranosa, keadaan di mana lapisan mukosa usus besar dilapisi oleh suatu selaput yang menghalangi fungsi usus besar untuk mengabsorpsi cairan.

Diagnosis Diare
 
Dokter akan menanyakan beberapa hal mengenai gejala-gejala yang terjadi dan menentukan apakah telah terjadi dehidrasi. Beritahu dokter obat-obatan yang sedang dikonsumsi, termasuk obat yang dibeli bebas.

Dokter kemudian akan melakukan pemeriksaan perut untuk melokalisasi nyeri yang dirasakan, mendengarkan suara perut (bising usus) dengan menggunakan stetoskop, dan melakukan pemeriksaan melalui anus jika diperlukan. Jika diarenya berat ataupun telah kronik, biasanya akan dilakukan pemeriksaan feses.

 
Tata Laksana Diare
 

Untuk anak yang menderita diare dengan dehidrasi ringan, pemberian makanan maupun susu dapat diteruskan seperti biasa, tapi mungkin dengan jumlah yang lebih sedikit namun dengan frekuensi yang lebih sering. Pemberian ASI harus diteruskan. Jika anak terlihat kembung ataupun sering flatus setelah minum susu sapi ataupun susu formula, segera berkonsultasi dengan dokter untuk mengubah pola makan sementara waktu.

 
Untuk anak dengan diare sedang masih dapat dirawat di rumah dengan observasi ketat, pemberian cairan khusus, dan konsultasi dokter. Dokter akan merekomendasikan jumlah dan lamanya penggunaan cairan khusus yang diperlukan. Nantinya anak dapat kembali memulai pola makannya seperti biasa lagi. Beberapa anak yang sedang menderita diare tidak dapa mentoleransi susu sapi sehingga dokter menganjurkan untuk menghentikan sementara pemberiannya. Pemberian ASI terus diberikan.

Berbagai CRO telah dibuat oleh pabrik obat untuk mengganti kehilangan cairan dan elektrolit selama terjadinya diare. Cairan tersebut sangat membantu dalam tata laksana diare. Utamakan menggunakan yang generik, karena selain lebih murah, efektivitasnya sama dengan yang paten. Selain itu orang tua dapat membuat sendiri CRO dengan cara mencampurkan 1 sendok teh garam dan 8 sendok teh gula kedalam 1 liter air matang.

 
Cara Menyiapkan Cairan Rehidrasi Oral

1.     Cuci tangan sebelum mambuat CRO.

2.     Campurkan 1 sendok teh garam dan 8 sendok teh gula atau 1 paket CRO dengan air matang.

3.     Cuci tangan anda dan anak anda sebelum memberikan CRO.

4.     Berikan anak CRO sesuai kebutuhan, sedikit-sedikit namun sering.

5.     Berikan juga cairan pengganti lainnya, seperti ASI dan jus buah.

6.     CRO tidak menghentikan diare, tapi mencegah terjadinya dehidrasi. Diare akan berhenti sesuai perjalanan penyakitnya.

7.     Jika anak muntah, tunggu 10 menit baru berikan CRO, biasanya muntah akan berhenti.

Jika anak tidak muntah, pemberian CRO dapat diberikan hingga frekuensi buang air kecil anak normal kembali.

Jika anak mengalami diare dengan dehidrasi berat, cairan pengganti mungkin diberikan melalui selang infus di ruang gawat darurat selama beberpa jam untuk memperbaiki keadaan dehidrasi. Biasanya tidak diperlukan perawatan di rumah sakit.

Pemberian antibiotika tidak akan menyembuhkan diare yang disebabkan oleh virus yang merupakan penyebab tersering terjadinya diare. Pemberian anti diare sebaiknya tidak digunakan karena justru menyebabkan perjalanan penyakit berlangsung lebih lama dan pasien menjadi karier yang dapat menularkan ke orang lain.

Selama penyakit ini berjalan secara alamiah berikut beberapa hal yang harus dan yang tidak boleh dilakukan.

Harus dilakukan:

- Memperhatikan apakah terdapat tanda-tanda dehidrasi seperti, berkurangnya frekuensi buang air kecil, tidak ada air mata saat menangis, demam tinggi, mulut kering, berat badan turun, anak terlihat sangat kehausan,lesu tidak bergairah, kelopak - Laporkan dokter jika terdapat darah pada fesesnya ataupun demam tinggi (lebih dari 390C).
- Teruskan pemberian makan seperti biasa jika anak tidak muntah. Namun berikanlah dalam jumlah yang lebih sedikit ataupun berikan makanan yang tidak membuat perut anak merasa tidak enak.

- Berikan cairan pengganti khusus jika anak haus.

Tidak boleh dilakukan:

- Membuat sendiri cairan pengganti di rumah tanpa panduan yang benar.
- Tidak memberikan anak makan saat lapar.
- Memberikan susu yang direbus, ataupun kaldu daging maupun sup yang asin.
- Memberikan obat-obat “anti-diare”.

 
Konsultasi Dokter
 
Orang tua harus segera berkonsultasi dengan dokter apabila anak berusia kurang dari 6 bulan atau memiliki gejala-gejala:
- Diare berlangsung lebih dari 1  minggu.
- Terdapat darah pada fesesnya.
- Muntah yang sering.
- Nyeri perut.
- Demam tinggi.
- Terlihat sangat lemah.

Tanda-tanda dehidrasi, seperti:
- Frekuensi buang air kecil berkurang (kurang dari 6 popok/hari).
- Tidak ada air mata ketika menangis.
- Tidak mau minum.
- Mulut kering.
- Berat badan turun.
- Terlihat sangat kehausan.
- Terlihat mengantuk dan tidak responsif.

Sedangkan orang tua tidak perlu terburu-buru berkonsultasi dengan DOKTER jika anak terlihat baik-baik saja meskipun disertai dengan gejala-gejala:

- Frekuensi buang air besar yang sering ddan dengan feses yang banyak.
- Sering flatus.
- Feses berwarna kuning ataupun hijau.

Pencegahan Diare

Beberapa hal dapat dilakukan untuk mencegah terjadinya diare, antara lain:
- ASI eksklusif selama 6 bulan
- Sumber air bersih dan sanitasi yang baik.
- Imunisasi campak, terutama sebelum menyentuh makanan.
- Mencuci tangan.
- Buang air besar di kakus.
- Gunakan produk terbuat dari susu yang telah dipasteurisasi untuk membunuh bakteri.
- Jangan biarkan makanan pada suhu ruangan oleh karena dapat merangsang pertumbuhan bakteri.
- Masaklah makanan dan air minuman hingga matang.

Muntah

Pada anak-anak, muntah biasanya terjadi karena berbagai rangsangan, antara lain, sakit, menelan bahan toksik, ataupun stres emosional akibat tekanan di lingkungan sekolah maupun rumah.

Muntah yang hanya terjadi satu kali tidak perlu dikhawatirkan. Sedangkan muntah yang berlangsung berulang kali dapat merupakan petanda bahwa anak memerlukan bantuan medis. Terutama apabila disertai dengan gejala-gejala seperti nyeri perut, demam, ataupun sakit kepala.

Segera berkonsiltasi dengan dokter apabila muntah yang terjadi disertai dengan gejala-gejala:
- Nyeri perut.
- Terdapat darah ataupun cairan empedu (berwarna hijau) pada muntah.
- Anak terlihat linglung, apatis, dan menjadi cengeng.
- Telah mengalami diare lebih dari 12 jam.
- Terdapat tanda-tanda dehidrasi.
- Selalu muntah setiap sehabis diberi makan dalam 12 jam terakhir.

 
Tata Laksana Muntah

Muntah biasa terjadi pada anak dan sering membuat rasa tidak nyaman. Walaupun begitu, biasanya mintah yang terjadi tidak berbahaya dan segera berakhir. Selama muntah, harus diperhatikan jangan sampai terjadi dehidrasi akibat kehilangan cairan, terutama apabila disertai dengan gejala demam dan diare. Biasanya anak tidak akan napsu makan, maka teruslah mendorong anak untuk selalu minum. Biarkan anak memilih minuman yang disukainya. Hindari pemberian minuman yang kadar gula dan kafeinnya tinggi karena justru akan membuat anak menjadi sering buang air kecil dan memperburuk terjadinya kehilangan cairan.

Ketika muntahnya telah berhenti selama beberapa jam dan tidak terjadi lagi kehilangan cairan, mulailah memberinya makanan yang ia suka. Beberapa pilihan antara lain roti panngang, bubur gandum, pisang, saus apel, ataupun telur rebus. Sebaiknya jangan berikan makanan yang terbuat dari susu maupun makanan yang mengadung serat tidak larut dalam air seperti sayuran dan buah berserat, serta sereal kulit padi hingga perut anak terasa sudah lebih nyaman. Segera berikan pola makan seperti biasa kembali jika keadaan anak sudah membaik.

Dehidrasi
 
Dehidrasi adalah keadaan dimana tubuh kehilangan cairan dan elektrolit. Padahal cairan dan elektrolit sangat dibutuhkan oleh tubuh agar dapat berfungsi dengan baik. Anak-anak, terutama usia dibawah 1 tahun adalah kelompok yang rentan mengalami dehidrasi. Penyebab paling sering terjadinya dehidrasi pada anak adalah diare dan muntah, serta kurang minum pada saat sedang demam.

Derajat dehidrasi diklasifikasikan berdasarkan gejala dan tanda yang timbul yang merefleksikan jumlah cairan dan elektrolit yang hilang. Pada tahap awal dehidrasi, biasanya tidak ada gejala dan tanda yang khas selain rongga mulut yang kering dan rasa haus, sehingga tahap ini sulit dideteksi. Dengan semakin beratnya dehidrasi yang terjadi, maka akan tampak gejala dan tanda antara lain, kehausan, gelisah dan cengeng, turgor kulit menurun, membran mukosa kering, kelopak mata cekung, ubun-ubun cekung (pada bayi), dan tidak adanya air mata saat anak menangis.

Berdasarkan gejala dan tanda, dehidrasi dibagi menjadi:

Dehidrasi ringan:

- Muka memerah.
- Rasa haus yang sangat.
- Kulit yang hangat dan kering.
- Tidak buang air kecil atau berkurangnya volume urin dan berwarna lebih gelap.
- Pusing dan lemah.
- Kram pada otot kaki dan tangan.
- Menangis dengan sedikit atau tidak ada air mata.
- Mengantuk.
- Mulut dan lidah kering disertai berkurangnya air liur.

Dehidrasi sedang:
- Tekanan darah menurun.
- Pingsan.
- Kontraksi yang kuat pada otot lengan, kaki, perut, dan punggung.
- Kejang.
- Perut kembung.
- Gagal jantung.
- Ubun-ubun cekung.
- Kelopak mata cekung.
- Kulit menjadi keriput dan tidak elastis (ketika kulit dicubit tidak cepat kembali ke posisi semula).
- Bernapas cepat dan dalam.
- Denyut nadi yang cepat dan lemah.

Dehidrasi berat

Gejala-gejala  pada dehidrasi ringan makin jelas terlihat. Dan kemudian dapat mengalami keadaan yang lebih berat berupa syok hipovolemik dengan gejala-gejala berkurangnya kesadaran, tidak buang air kecil, tangan dan kaki teraba dingin dan lembab, denyut nadi yang semakin cepat dan lemah hingga tidak teraba, tekanan darah yang menurun hingga tidak dapat diukur, serta kebiruan pada ujung kuku, mulut, dan lidah. Jika tidak segera diatasi, keadaan ini dapat mengancam jiwa.
 

Tata Laksana Dehidrasi
 

Pada dehidrasi ringan, berikan 100-200 ml cairan rehidrasi oral (CRO) setiap habis diare  (50-100 ml untuk anak dibawa 2 tahun). Pada dehidrasi sedang, selain pemberian CRO setiap habis diare, dalam 4 hingga 6 jam pertama harus diberikan CRO yang kebutuhannya disesuaikan dengan berat badan dan usia anak (lihat table). Pada dehidrasi berat, pemberian CRO harus diberikan melalui infus.
 

 
Kesimpulan
- Diare pada anak paling banyak disebabkan oleh virus (Rotavirus) dan akan sembuh sendiri dalam waktu 1 minggu.
- Anak tertular diare terutama melalui kontak langsung.
- Selama diare, teruskan pemberian ASI dan pola makan seperti biasa.
- Pengobatan utama adalah rehidrasi untuk mengganti cairan dan elektrolit yang hilang serta mencegah terjadinya dehidrasi.
- Antibiotika tidak diperlukan untuk mengobati diare yang disebabkan oleh virus.
- Anti diare juga tidak boleh diberikan karena justru dapat memperpanjang perjalanan penyakit dan membuat virus penyebab masih ada di dalam tubuh sehingga pasien menjadi karier yang dapat menularkan ke orang lain.

(Dirangkum dari berbagai sumber) 

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