Case Report

Competency

Competency Standards of Medical Doctors in Indonesia (2019)

Gastroenteritis : 4
Dehydration mild moderate :
Complex Febrile Seizure : 4
Hipocalcemia
Hipocalemia
CHAPTER I
INTRODUCTION
 BACKGROUND

GASTROENTRITIS
Gastroenteritis is defined as inflammation of the mucous membranes of the
digestive tract which is characterized by diarrhea or vomiting. In Indonesia,
gastroenteritis is still a big problem, especially gastroenteritis caused by
infection and non-infection.
Diarrhea and gastroenteritis occupy the fifth position in the top ten most common diseases in outpatients in
2010. Basic Health Research results show the prevalence of diarrhea in 2007 was 9%, then decreased in
2013 to 7%. In 2015, the diarrhea morbidity rate reached 214/1000 people or around 5,405,235 cases of
diarrhea, of which 74.3% of these cases were hospitalized (Simadibrata, M and Adiwinata, R, 2017).

Gastroenteritis is closely related to cleanliness

The incidence of gastroenteritis and its causative factors such as food consumed,
especially in the group of children.
 Patophysiology Acute Gastroenteritis

Modes of transmission of enteropathogens are via person-to person,

by fecal–oral route, or by ingestion of contaminated food or water.
Incubation periods usually range between 1 h (toxin-producing
bacteria: S. aureus) and 7 days (invasive bacteria as Shigella).
However, for some bacteria, incubation periods can be up to 14 days
(Salmonella) and for some parasites up to weeks or months (E.
histolytica).
Etiology Acute Gastroenteritis
Classification Acute Gastroenteritis
Closely related to dehydration
 Assesment
An episode of acute watery diarrhea is characterized by loose or liquid
stools, which can be accompanied by hyporexia, vomiting, fever, and
abdominal pain. Less frequently, the disease can present as dysentery:
bloody diarrhea associated with high fever and toxicity. These episodes are
caused by Shigella, EIEC, and some strains of Salmonella and
Campylobacter. Parasitic infections can present as explosive and mucus or
bloody stools, cramping, tenesmus (E. histolytica), or as a malabsorption
syndrome (Giardia). (Florez I, et al. 2022)
 Treatment
Children with acute gastroenteritis rarely require intravenous (IV) access. In those
presenting with circulatory collapse due to severe dehydration or sepsis, IV access
should be obtained and followed by an immediate 20-mL/kg bolus of normal saline.

If we find emergency condition, ex : dehydration  treat with dehydration

treatment
Differential Diagnosis
Congenital secretory diarrheas
Cryptosporidiosis
Giardiasis
Hemolytic-Uremic Syndrome
Hepatitis
Inflammatory Bowel Disease
Pediatric Appendicitis
Pediatric Crohn Disease
Pediatric Diabetic Ketoacidosis (DKA)
Pediatric Lactose Intolerance
Pediatric Pancreatitis
Pediatric Pyelonephritis
Pediatric Urinary Tract Infection
Pediatrics, Foreign Body Ingestion
Pediatrics, Intussusception
Pediatrics, Pyloric Stenosis
Peptic Ulcer Disease
Pseudomembranous colitis
Shock in Pediatrics
Shock, Septic
Sinonasal Manifestations of Cystic Fibrosis
Toxic ingestion
Toxic megacolon
 Prognosis
The prognosis is good for most patients with viral gastroenteritis, however, if unrecognized
dehydration occurs, the affected person will become seriously ill and die. Patients who recover
from viral gastroenteritis usually have a good prognosis, because there are no long-term
consequences. (Prescilla R, 2023)
 Prevention
There are so many way to avoid acute gastroenteritis, some of them are improve child hygiene
to ensure that whatever is consumed is clean, provide the best nutrition for children because
with good nutrition it is hoped that the child's immunity will also get stronger and the most
important thing is don't forget to give the anti-rotavirus vaccine. (Prescilla R, 2023)
 BACKGROUND

DEHYDRATION
Definition  Dehydration is a common condition that affects patients of all ages. Dehydration may complicate other medical
problems and may cause significant illness.

Epidemiology
The elderly population is also 20% to 30% more prone to developing dehydration due to immobility, impaired thirst mechanism,
diabetes, renal disease, and falls.

Patophysiology
Dehydration stimulates the thirst center in hypothalamus  conservation of water by the kidney  . When the hypothalamus
detects lower water concentration  posterior pituitary to release antidiuretic hormone (ADH)  kidneys to reabsorb more water
 Decreased blood pressure, which often accompanies dehydration, triggers renin secretion from the kidney. Renin converts
angiotensin I to angiotensin II, which increases aldosterone release from the adrenals. Aldosterone increases the absorption of
sodium and water from the kidney. Using these mechanisms, the body regulates body volume and sodium and water
concentration.
 DEHYDRATION
The source of water loss may also understand the etiologies of dehydration:

- Failure to replace water loss: altered mentation, immobility, impaired thirst mechanism, drug
overdose leading to coma
- Excess water loss from the skin: heat, exercise, burns, severe skin diseases
- Excess water loss from the kidney: medications such as diuretics, acute and chronic renal disease,
post- obstructive diuresis, salt-wasting tubular disease, Addison disease, hypoaldosteronism,
hyperglycemia
- Excess water loss from the GI tract: vomiting, diarrhea, laxatives, gastric suctioning, fistulas
- Intraabdominal losses: pancreatitis, new ascites, peritonitis
- Excess insensible loss: sepsis, medications, hyperthyroidism, asthma, chronic obstructive pulmonary
disease (COPD), drugs
 DEHYDRATION
Cinical Assesment

- Some of the most common presenting symptoms  fatigue, thirst, dry skin and lips, dark urine or
decreased urine output, headaches, muscle cramps, lightheadedness, dizziness, syncope, orthostatic
hypotension, and palpitations.
- Vital signs may show hypotension, tachycardia, fever, and tachypnea.
- The physical examination could show dry mucosa, skin tenting, delayed capillary refill, or cracked lips.
- Historical and physical findings tested were dry axilla, mucous membranes, tongue, increased capillary
refill time, poor skin turgor, sunken eyes, orthostatic blood pressure drop, dizziness, thirst, urine color,
weakness, blue lips, altered mentation, tiredness, and appetite.
 DEHYDRATION
Treatment

- Treatment of dehydration is aimed at rapid fluid replacement as well as identification of the cause of fluid
loss. Patients with fluid deficits should be given isotonic fluid boluses tailored to the individual circumstance.
- Blood pressure, heart rate, serum lactate, hematocrit (if bleeding, there is no blood loss), and urine output
may be used to assess the volume deficit and to assess response to fluids.
- The choice of crystalloid should be customized to the patient. Normal saline lactated Ringer's solution and a
balanced crystalloid solution may all be used
 DEHYDRATION
Prognosis

When the underlying cause of dehydration is treated, and the patient's volume has been restored,
the majority of patients recover fully. Failure to treat dehydration in older adults may lead to
significant mortality
 DEHYDRATION
Complication

Altered mental status, renal failure, shock liver, lactic acidosis, hypotension, and death are related
to organ-hypoperfusion. Fluid and electrolyte abnormalities such as uremia, hyponatremia,
hypernatremia, hypokalemia, hyperkalemia, metabolic acidosis, and metabolic alkalosis,
pulmonary edema. In patients with severe hyponatremia, volume correction may cause a rapid
rise in sodium, which can cause central pontine myelinolysis.
 BACKGROUND

COMPLEX FEBRILE SEIZURE

Definition based on consensus management of seizures fever from the Indonesian Pediatrician
Association / IDAI, febrile seizures are seizures that occurs when the body temperature rises
(rectal temperature over 38 C) caused by an extracranial process

CLASSIFICATION
Febrile seizures are divided into two-> simple febrile seizures and convulsions
complex fever

Seizures Complex fever usually shows unilateral focal or partial seizures

or generalized seizures preceded by seizure Partial. Its duration is more than 15 minutes and
repeated or more than 1 seizure during 24 hours.
 COMPLEX FEBRILE SEIZURE
Patophysiology

The exact pathophysiology of febrile seizures is not understood. There is a recognized genetic
predisposition with 10% to 20% of first-degree relatives of patients with febrile seizures also
experiencing febrile seizures. No specific mode of inheritance is known.
 COMPLEX FEBRILE SEIZURE
Clinical Assesment

Simple febrile seizures occur more commonly than complex febrile seizures and are characterized by a seizure that is
generalized, lasts less than 15 minutes, and does not recur within 24 hours. Complex febrile seizures are characterized by
the presence of at least one of the following features: focality, duration of longer than 15 minutes, and recurrence within a
24-hour period. In either instance, a general physical exam and neurologic exam are necessary.

Post-ictal drowsiness is not abnormal in febrile seizures but typically resolves within a few minutes. A patient recovering
from a febrile seizure will rapidly return to baseline and towards a normal neurologic exam. If a patient does not return to
baseline, remains completely unresponsive to noxious stimuli after the seizure, or has other symptoms of acute neurologic
dysfunction before the seizure (such as acute headaches, alteration of mental status, or concern for weakness), etc.
 COMPLEX FEBRILE SEIZURE
Treatment

- There is no specific treatment for simple or complex febrile seizures other than appropriate
treatment for underlying etiologies driving the ongoing febrile illness.
-Antipyretics have not been shown to prevent a recurrence of febrile seizures.
- A frequent recurrence of febrile seizures such as seizures with a majority of febrile illnesses
benzodiazepines as a bridging measure for a few days during subsequent febrile events.
- Rectal diazepam is used to abort this disorder if it lasts more than 5 minutes. There are also
recommendations for intranasal midazolam. Patients with febrile status epilepticus are at risk for
future episodes of the same event.
COMPLEX FEBRILE SEIZURE
Differential Diagnosis

Aseptic meningitis
Bacterial meningitis
Encephalitis
Tonic-clonic seizures
 COMPLEX FEBRILE SEIZURE
Prognosis

About 1-2% of children with simple febrile seizures - only slightly higher risk than the general
population- develop subsequent epilepsy. However, children with complex febrile seizures, abnormal
neurodevelopment, or with a family history of epilepsy have a higher risk of epilepsy(approximately 5-
10%). There is no evidence that febrile seizures are linked to learning disabilities or lower intelligence
CHAPTER II
PATIENT STATUS
 Patient Identity

Name : EOZP
Gender : Female
Medical Record : 00.88.69.90
Date of birth : April 16th, 2021
Age : 2 Years, 0 Months, 2 days
Address : DSN IV Kuala Tanjung
Hospital Entry Date : April 17th 2023
 History Taking

Subjective : diarrhea and fever

History :
EOZP, a 2-year, 0-month, 2 days Female was admitted to the ER in Hospitalon Monday, April 17th
2023, with the main complaint of diarrhea and fever
The patient’s mother reported that the diarrhea had been experienced by the patient for the past 6
days. The diarrhea frequency is > 4x in one day . Greenish yellow diarrhea accompanied by mucus
, diarrhea with more dregs than water. No blood was found .The fever characteristics were high
with the highest recorded temperature of 39,1 C and the lowest temperature of 37.6 C . The
patient’s mother claimed that the fever only subside in a while with the use of paracetamol.
History Taking
● The patient’s mother also reported that the patient’s appetite was slightly lowered , patient only
drink breast milk .
● The patient mother denied any nausea, vomiting, or abdominal tenderness and/or pain.
● The patient’s urination were within normal range and no complaints were found.
History of Previous Illness :
● The patient had previously visited a doctor and was treated in RS Sapta Medika Kisaran . The
patient was diagnosed with GEA + Complex Febrile Seizure one year ago
● The patient was treated as outpatient with diagnosis of Speech Delayed and Motoric Delayed
History of Medication :

▪ The patient’s family did not remember the patient’s medication history. The patient’s family only
remembered that they gave the patient paracetamol

▪ Dosage and brand were unknown.

History of Family Illness : -
 History Taking
History of Pregnancy :
The patient is the first child in the family. The mother’s age during gestation was 31 years old.
The patient’s mother claimed that she had routine check-ups to an OBGYN specialist
throughout the pregnancy. The patient’s mother denied any illnesses during pregnancy, and
claimed that she only consumed prenatal vitamins and no other medications throughout the
pregnancy.
History of Birth :
The patient was delivered through a Caesarean section delivery. The patient’s gestational age
was more than normal, 42 weeks. The patient’s mother reported that the patient immediately
cried after birth, and had an active tone. History of cyanosis or jaundice were denied by the
patient’s mother, and the patient was not admitted to the ICU and used an incubator
throughout her care.
Birth Weight : 3.9 kg , Length Birth : 51 cm
 History Taking
History of developmental :

● 3 months : The patient was able to lift and move her own head.
● 6 months : The patient was able to sit with support.
● 9 months : The patient was able to stand up with help.
● 1 year : The patient was not able to walk without support after the seizure attack
● 2 year : The patient can only babble one word

● The parents did not specifically remember the patient’s development, and therefore, the patient’s
development history was vague. The patient’s mother claimed that the patient is currently able to
babble one word and understand when being spoken to.
 History Taking
History of Immunization
• 0 months : Hepatitis B 0, BCG, Polio 0
• 2 months : DPT 1, HiB 1, Polio 1
• 3 months : DPT 2, HiB 2, Polio 2
• 4 months : DPT 3, HiB 3, Polio 3
• 9 months : MR 0

• The patient’s basic immunization was complete, but booster

immunization was not given to the patient.
 History Taking

History of Nutrition
• 0 months – 6 months : Breast Milk
• 6 months – 9 months : Breast Milk + Formulated Milk + Weaning food, such
as porridge

• 9 months – 1 year rice : : Breast Milk + Weaning food, such as steamed

(nasi stim)
• 1 year – Now : Breast Milk + Regular household foods
 Presence Status
• Sensorium : Compos Mentis

• TD : 100/60

• HR : 123 bpm (N : 65-110 x/i)

• RR : 48 bpm (N : 20-25x/i)

• T : 37.9 oC

• SpO2: 99% RA
 Anthropometry

EOZP, a 2-year, 0-month, 4 days , Female

BB 9.3 kg

TB 80 cm

BB/U -3 < z < -2 :

TB/U -3 < z < -2 :

BB/TB -2 < z < -1 :

 Physical Examination

Head
Eyes : Light Reflex (+/+), isochor pupils 2mm in diameter, pale inferior palpebra
conjunctiva (+/+), icteric sclera (-/-)
Ears/Nose : Within normal limits, no secret/ nostril breathing was not found , cyanosis was not found.
Mouth : Dry mucosa (-)
Neck : No cervical lymph node enlargement
Chest : Symmetrical, retraction (-)

• HR : 123 bpm, regular, murmur (-)

• RR : 48 bpm, rhonchi (-), wheezing (-)

Abdomen: Supple, normal peristaltic sound (+), distention (-), abdominal tenderness (-)

Extremity : warm acral , CRT < 2 seconds

 Laboratorium Results
April 17 2023

Parameter Result Reference Range Unit

Haemoglobin 9.4 10.8-15.6 g/dl

Haematocrit 28 33-45 %
Leukocyte 10.5 4.5-13.5 × 103/µl
Erythrocyte 4.10 4.50-6.50 103/µl
Thrombocyte 492 181-521 103/µl
MCV 70 69-93 FL
MCH 22.9 22-34 pg
MCHC 32.9 32-36 g%
RDW 16.4 11-15 %
PDW 7.9 10-18 %
MPV 8.4 6.5-9.5 FL
Seg. Neutrophil 58.80 25-60 %
Lymphocyte 30 25-50 %
Monocyte 10.10 1.00-6.00 %
Eosinophil 0.90 1.00-5.00 %
Basophil 0.2 0.00-1.00 %
Abs. Neutrophil 6.21 2.4-7.3 103/µl
Abs. Monocyte 1.07 0.2-0.6 103/µl
Abs. Eosinophil 0.09 0.10-0.30 103/µl
Abs. Basofil 0.02 0.0-0.1 103/µl
Urinalysis
Differential Diagnosis

● GEA ec Bacterial Infection

● GEA ec Viral Infection
● GEA ec Amoebiasis
 Working Diagnosis

● GEA + Mild Moderate Dehydration + Complex

Febrile Seizure + Hipocalcemia + Hipokalemia
 Treatment

● IVFD D5% NaCl 0,45% 40 cc/hour

● Inj. Paracetamol 100 mg
● Zinc 1 x 20 mg
● Oralit 50-100 cc / for each diarrheal stool
● Sefotaksim 500mg /12 hours
 Planning

• Monitor the patient’s vital sign.

• Observe the patient for any signs of infection.
• Educate the patient’s parents to let the patient get plenty of rest.
• Educate the patient’s parents to let the patient drink more .
CHAPTER III
FOLLOW UP
April 17 2023

S Diarrhea (+), vomiting (-), shortness of breath (+), seizure history (+)
O Sens : Compos Mentis
  Eye : Light reflex (+/+), pupil isochor
  Neck : Enlargement of the KGB not found
  Thorax : Symmetrical fusiform, retraction (-)
  Temperature : 36.9℃
  HR : 110x/i, regular, sigh (-)
  RR : 22x/i, regular, crackles (-)
  Abdomen : Soepel, peristalsis (+)
  Extremities : Warm Acral, CRT<3”
A
Acute Gastroenteritis with mild-modearate dehydration + complex seizure + hipocalsemia + hipocalemia

- IVFD RL 3 CC/kgbb/hour = 75 CC/hour  700 cc/4 jam

- Paracetamol inj 100 mg (K/P)
P - Zinc 1 x 20mg
- Oralit 50-100 cc/ when diarrhea back
- Calsium correction with Ca Gluconas 4,5cc + 4,5cc NaCl 0,9% (20 minutes)
- Calium correction 0,75 x 9,3 = 7meq KCL in 35 ml NS (3 hour) minutes)
- Monitor ECG
April 18 2023

S
Patient was diarrhea in 1 time since this morning. Slimy diarrhea (+). Fever (+), seizure (-), vomitus (-)
O Sens : Compos Mentis
  Eye : Light reflex (+/+), pupil isochor
  Neck : Enlargement of the KGB not found
  Thorax : Symmetrical fusiform, retraction (-)
  Temperature : 38℃, Blood Pressure : 90/50
  HR : 113x/i, regular, sigh (-), SPO2 : 99%
  RR : 21x/i, regular, crackles (-)
  Abdomen : Soepel, peristalsis (+)
  Extremities : Warm Acral, CRT<3”
A
Acute Gastroenteritis with mild-modearate dehydration + complex seizure + hipocalsemia + hipocalemia + speech and motoric delay

- IVFD D5% NaCl 0,45% 40 cc/jam

P - Inj. Paracetamol 100mg (K/P)
- Zinc 1x20mg
- Oralit 50-100cc (when diarrhea back)
- Cefotaxime 500mg/12 hour
April 19 2023

S
Patient was diarrhea in 1 time since this morning. Slimy diarrhea (+). Fever (-), seizure (-), vomitus (-)
O Sens : Compos Mentis
  Eye : Light reflex (+/+), pupil isochor
  Neck : Enlargement of the KGB not found
  Thorax : Symmetrical fusiform, retraction (-)
  Temperature : 37℃, Blood Pressure : 90/50
  HR : 113x/i, regular, sigh (-), SPO2 : 99%
  RR : 26x/i, regular, crackles (-)
  Abdomen : Soepel, peristalsis (+)
  Extremities : Warm Acral, CRT<3”
A
Acute Gastroenteritis with mild-modearate dehydration + complex seizure + hipocalsemia + hipocalemia + speech and motoric delay

- IVFD D5% NaCl 0,45% 40 cc/jam

P - Inj. Paracetamol 100mg (K/P)
- Zinc 1x20mg
- Oralit 50-100cc (when diarrhea back)
- Cefotaxime 500mg/12 hour
April 23 2023

S Diarrhea (-). Fever (-), seizure (-), vomitus (-)

O Sens : Compos Mentis

 
Eye : Light reflex (+/+), pupil isochor

 
Neck : Enlargement of the KGB not found

 
Thorax : Symmetrical fusiform, retraction (-)

 
Temperature : 37℃, Blood Pressure : 90/50

 
HR : 122x/i, regular, sigh (-), SPO2 : 99%

 
RR : 26x/i, regular, crackles (-)

 
Abdomen : Soepel, peristalsis (+)

 
Extremities : Warm Acral, CRT<3”

A
Acute Gastroenteritis with mild-modearate dehydration + complex seizure + hipocalsemia (post correction) + hipocalemia (post correction)+
speech and motoric delay

P
Therapy continue
April 24 2023

S Patient has no complaint

O Sens : Compos Mentis

 
Eye : Light reflex (+/+), pupil isochor

 
Neck : Enlargement of the KGB not found

 
Thorax : Symmetrical fusiform, retraction (-)

 
Temperature : 37℃, Blood Pressure : 90/50

 
HR : 122x/i, regular, sigh (-), SPO2 : 99%

 
RR : 26x/i, regular, crackles (-)

 
Abdomen : Soepel, peristalsis (+)

 
Extremities : Warm Acral, CRT<3”

A
Acute Gastroenteritis with mild-modearate dehydration + complex seizure + hipocalsemia (post correction) + hipocalemia (post correction)+
speech and motoric delay

P
Patient may rest in home. Re-control to hospital 26/04/2023. Continue therapy zinc 1x20mg at home.
CHAPTER IV
DISCUSSION
DEFINITION & EPIDEMIOLOGI
o Definition
Gastroenteritis is defined as the inflammation of the mucus membranes of the gastrointestinal
tract and is characterized by diarrhea or vomiting.
o Epidemiology
Children in developing countries are particular at risk of both morbidity and mortality.
Worldwide , gastroenteritis affects 3 to 5 billions children each year and accounts for 1.5 to 2.5
milion deaths per year or 12 % of all deaths among children less than 5 years of age.
 Definition
Theory Case
Gastroenteritis is inflammation of the stomach, small intestine, or large In this case, the patient was a girl aged 2 years 2 days who came with
intestine, leading to a combination of abdominal pain, cramping, the main complaint of diarrhea. Diarrhea experienced since 5 days ago
nausea, vomiting, and diarrhea. Acute gastroenteritis usually lasts before patient come to hospital.
fewer than 14 days. (Graves, 2013).
Diarrhea occurred five times in one day with a greenish-yellow color,
  liquid consistency, mucus and no blood.

Febrile seizures are seizures that are caused by a sudden spike in  

body temperature with fevers greater than 38C or 100.4F, with no other
The patient also had a high fever for the past 5 days along with the
underlying seizure-provoking causes or diseases such as the central
main complaint. the highest fever was at 38.9, a history of seizures was
nervous system (CNS) infections, electrolyte abnormalities, drug
found 3 days ago 2 times with a duration of less than 5 minutes. during
withdrawal, trauma, genetic predisposition or known epilepsy. Febrile
a seizure the eyes roll up and the legs and arms twitch, after the
seizures categorize as either simple febrile seizures or complex febrile
seizure the patient wakes up. The patient's family decided to take the
seizures. (Xixis, 2023)
patient to the Hospital and the patient was diagnosed with Acte
Gastrenteritis with mild moderate dehydration and Complex seizure
ETIOLOGY
 Etiology
Theory Case
Several different viruses including rotavirus, In this case, acute gastroenteritis was suspected due
norovirus, adenovirus, and astroviruses account for to viral infection. the presence of a viral infection
most cases of acute viral gastroenteritis. Most are triggers fever in patients and is a risk factor for
transmitted via the fecal-oral route, including complex febrile seizures in cases
contaminated food and water. (Graves, 2013)

There is no specific cause of fever that is more

likely to cause febrile seizures, however, viral rather
than bacterial infections are most commonly
associated with febrile seizures. (Xixis, 2023)
 Risk Factor
Theory Case
Risk factors for gastroenteritis: In this case, there was no history of other gastrointestinal diseases.

Risk factor of chronic gastroenteritis Causes of persistent

or chronic gastroenteritis include parasitic infections,
medications, inflammatory bowel disease (ulcerative colitis,
Crohn disease, collagenous colitis, and microscopic colitis),
irritable bowel syndrome, eosinophilic gastroenteritis, celiac
disease, lactose intolerance, colorectal cancer, bowel
obstruction, malabsorption, and ischemic bowel. (Graves,
2013)
Clinical Manifestation and Symtomps
Clinical Signs Associated With Dehydration
 Diagnosis
Theory Case
Diagnosis of Gastroenteritis: In this case the patient complained
a. Anamnesis:  Nausea, vomiting, fever, or abdominal pain. Symptoms usually last for less
Diarrhea occurred five times in one day with a greenish-yellow color, liquid
than a week, most often improving after 1 to 3 days. Mild fever and mild abdominal pain are
consistency, mucus and no blood. bfvThe patient also had a high fever for the past 5
common. Vomiting is present in most but not all cases. Symptoms include high fever,
bloody diarrhea, protracted vomiting, or severe abdominal pain. days along with the main complaint. the highest fever was at 38.9, a history of
seizures was found 3 days ago 2 times with a duration of less than 5 minutes.
b. Physical examination:

Mild fever is common in viral gastroenteritis, but high fever (greater than 39 C) should trigger concern
for causes that are not viral in origin. Additionally, tachycardia and tachypnea may be present due to
fever and dehydration. An assessment for dehydration is of the utmost importance, especially in
patients who demonstrate extremes of age, chronic illness, or immunosuppression.

c. Laboratory Examination, consisting of:

Complete blood counts may reveal a mild leukocytosis in a patient with viral gastroenteritis. Other
serum inflammatory markers may also show mild elevation. Patients who are suffering from
significant dehydration may demonstrate hemoconcentration on complete blood count testing as
well as electrolyte disturbances on chemistry panels. Dehydration may also present as acute kidney
injury, evidenced by changes in the BUN and creatinine on a chemistry panel. (Graves, 2013)

Complex febrile seizures are characterized by the presence of at least one of the following features:
focality, duration of longer than 15 minutes, and recurrence within a 24-hour period. (Xixis, 2023)
 Diagnosis
Theory Case
Diagnosis of Dehydrations: In this case there are no signs of dehydration, such as:
No Dehydratiojn : Not enough signs to classify as some or severe dehydration
• dry lip mucosa

• Restless irritable
Some Dehidratin:
• Sunken eyes
Two of the following signs:
• Drinks eagerly, thirsty
• Restless irritable

• Sunken eyes • Skin pinch goes back slowly.

• Drinks eagerly, thirsty

• Skin pinch goes back slowly.

Severe Dehydration:

Two of the following signs:

• Lethargic or unconscious

• Sunken eyes

• Not able to drink or drinking poorly

• Skin pinch goes back very slowly.

TREATMENT

o The broad principles of management of AGE in children include rehydration and

maintenance ORS plus replacement of continued losses in diarrheal stools and
vomitus after rehydration, continued breastfeeding, and refeeding with an age-
appropriate, unrestricted diet as soon as dehydration is corrected.
o Zinc supplementation is recommended for children in developing countries.
Integrated Management of Childhood Illnesses protocol for the
recognition and management of diarrhea in developing
countries. ORS, oral rehydration solution.

The management given to patients with

acute diarrhea needs to be adjusted
according to whether there are signs of
dehydration in the patient. Follow the fluid
therapy management guidelines in Fig
Fluid and Nutritional Management of Diarrhea
 Governance
Theory Case
• The treatment of viral gastroenteritis is based on symptomatic In this patient, treatment is given in the form of:
support . The most important goal of treatment is to maintain
 IVFD D5% NaCl 0,45% 40 cc/hour
hydration status and effectively counter fluid and electrolyte losses.
Inj. Paracetamol 100 mg
Fluid therapy is a fundamental part of treatment. Intravenous fluids 
may be administered to those individuals who appear dehydrated or  Zinc 1 x 20 mg
to those unable to tolerate oral fluids. Antiemetic medications such
 Oralit 50-100 cc / for each diarrheal stool
as ondansetron or metoclopramide may be used to assist with
Sefotaksim 500mg /12 hours
controlling nausea and vomiting symptoms. Patients demonstrating 
severe dehydration or intractable vomiting may require hospital  
admission for continued intravenous fluids and careful monitoring of
electrolyte status. (Graves, 2013)

• All children older than 6 mo of age with acute diarrhea in at-risk

areas should receive oral zinc (20 mg/day) in some form for 10-14
days during and continued after diarrhea.
 Return Criteria
Theory Case

Criteria for discharge: Based on the anamnesis, the patient has no complains
again.
 Absence of fever for at least 24 hours without taking
anti-fever therapy. Physical examination found a normal temperature
around 37⁰C, BP ​90/70, HR 122 x/minute, RR 26
 reduced blood in the stool
x/minute
 reduced diarrhea
The patient was discharged from the hospital on April 24,
 want to eat
2023
 can return to normal activities.
Conclusion
 Conclusion

A case of Acute Gastroenteritis with moderate dehydratin and Cmplex seizure has been reported in a
child aged 2 years 2 days. Diagnosis is based on anamnesis, physical examination and supporting
examinations. Treatment for this patient was Ringer Lactate IVFD, Paracetamol injection, Zinc 20 mg, Oralit
50-100 cc / for each diarrheal stool and Sefotaksim 500mg /12 hours. The patient experienced improvement
and went home on April 24, 2023.
 Blibiography

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