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Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods Hari Kushartono; Antonius H. Pudjiadi; Susetyo Harry Purwanto; Imral Chair; Darlan Darwis; Abdul Latief
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Background Base excess is a single variable used to quantifymetabolic component of acid base status. Several researches havecombined the traditional base excess method with the Stewartmethod for acid base physiology called as Fencl-Stewart method.Objective The purpose of the study was to compare two differentmethods in identifying hyperlactacemia in pediatric patients withcritical illness.Methods The study was performed on 43 patients admitted tothe pediatric intensive care unit of Cipto MangunkusumoHospital, Jakarta. Sodium, potassium, chloride, albumin, lactateand arterial blood gases were measured. All samples were takenfrom artery of all patients. Lactate level of >2 mEq/L was definedas abnormal. Standard base excess (SBE) was calculated fromthe standard bicarbonate derived from Henderson-Hasselbalchequation and reported on the blood gas analyzer. Base excessunmeasured anions (BE UA ) was calculated using the Fencl-Stewartmethod simplified by Story (2003). Correlation between lactatelevels in traditional and Fencl-Stewart methods were measuredby Pearsonâ€™s correlation coefficient .Results Elevated lactate levels were found in 24 (55.8%) patients.Lactate levels was more strongly correlated with BE UA (r = - 0.742,P<0.01) than with SBE (r = - 0.516, P<0.01).Conclusion Fencl-Stewart method is better than traditionalmethod in identifying patients with elevated lactate levels, so theFencl-Stewart method is suggested to use in clinical practice.

The benefit of co-trimoxazole treatment in the management of acute watery diarrhea caused by invasive bacterial infection Bobby Setiadi Dharmawan; Agus Firmansyah; Imral Chair
Paediatrica Indonesiana Vol 47 No 3 (2007): May 2007
Publisher : Indonesian Pediatric Society

Background World Health Organization (WHO) states thatantimicrobials are reliably helpful only for children with bloodydiarrhea (probable shigellosis), suspected cholera with severedehydration, and symptomatic infection caused by Giardia lamblia.The benefit of antimicrobial treatment in management of acutewatery diarrhea caused by invasive bacterial infection is still debated.Objective To prove the benefit of co-trimoxazole treatment inthe management of acute watery diarrhea caused by invasivebacterial infection in patients age 2â€“24 months.Methods This was a randomized, double blind clinical trialinvolving infants and children aged 2â€“24 months with acutewatery diarrhea caused by invasive bacterial infection withoutco-morbidity or complications. Invasive bacterial infection wasdefined by fecal leukocytes greater than ten cells (+2) per highpower field on stool. Subjects were assigned to receive either co-trimoxazole or placebo. The duration and frequency of diarrheabetween two groups were compared.Result Of 70 patients (co-trimoxazole, n=35; placebo, n=35),42 (60%) were children aged 12â€“24 months, of whom 61% wereundernourished. Males were affected 1.2 times as much as females.The clinical manifestations were mild-moderate dehydration(64%), mucus in the stool (100%), fever (24%), vomiting (10%),fever with vomiting (56%) and lactose malabsorption (53%).Duration of diarrhea in placebo group (mean 117.0 [SD 28.1]hours) was not significantly different (P=0.43) compared to thatin co-trimoxazole group (mean 122.5 [SD 30.1] hours). Frequencyof diarrhea per day in placebo group (mean 5.23 [SD 1.48] times)was not significantly different either (P=0.37) compared to thatin co-trimoxazole group (mean 5.64 [SD 2.20] times).Conclusion It is concluded that co-trimoxazole therapy providesno benefit to patients with acute watery diarrhea caused byinvasive bacterial infection. This disorder seems to be self-limited.

Profile of alanine aminotransferase and hepatic iron accumulation in thalassemic patients with or without anti-hepatitis C virus Purnamawati S P; Pamela Kartoyo; Imral Chair; Julfina Bisanto; Hanifah Oswari
Paediatrica Indonesiana Vol 44 No 3 (2004): May 2004
Publisher : Indonesian Pediatric Society

Background Repeated blood transfusions in thalassemic patientscause iron accumulation in tissues and might impair organ func-tion. Other peril of blood transfusion is hepatitis C virus infection.Objectives This study aimed to find out the proportion of increasedalanine aminotransferase (ALT), increased transferrin saturation(TS), and positive anti hepatitis C virus (anti-HCV) among thalas-semic patients and to get the profile of ALT among thalassemicpatients who have increased TS and positive anti-HCV.Methods This cross-sectional descriptive study was conductedon Î²- and Î²-HbE-thalassemic patients at the Thalassemia Outpa-tient Clinic, Department of Child Health, Medical School, Univer-sity of Indonesiaâ€“Cipto Mangunkusumo Hospital in May 2002.Results Subjects were 57 homozygous Î²-thalassemic and 33 Î²-HbE-thalassemic patients. No one had regular desferoxamine orhistory of splenectomy. Proportions of increased ALT, TS, and posi-tive anti-HCV were 76%, 78%, and 6%, respectively. Duration ofillness, total volume of packed red cell (PRC) transfusions, TS level,and positive anti-HCV seemed to have role in the increased pro-portion of subjects with increased ALT, whereas duration of illnessand total volume of PRC seemed to have role in the increased TS.Conclusion Factors that seem to have a role in the increasedproportion of subjects who had increased ALT and TS were (1)duration of illness, total volume of PRC transfusion, TS, and posi-tive anti-HCV; 2) duration of illness and total volume of PRC trans-fusion, respectively

Hepatitis B serologic patterns in children of HBV carriers or infected mothers Julfina Bisanto; Imral Chair; Dyah Istikowati
Paediatrica Indonesiana Vol 44 No 5 (2004): September 2004
Publisher : Indonesian Pediatric Society

Background Vertical transmission is usually the cause of increas-ing carrier rates for hepatitis B infection, especially in highly en-demic areas.Objective To determine the serologic patterns of hepatitis B inchildren of HBV carrier/infected mothers.Methods This was a cross sectional study on children of HBVcarrier/infected mothers. Subjects were recruited consecutively andexamined at the Department of Child Health, Cipto MangunkusumoHospital during Januaryâ€“July 2003. Children were included if theywere generally healthy and their parents gave permission. Chil-dren with chronic illness, previous blood transfusions, or drug abusewere excluded.Results Fifty-nine children of 32 HBV carrier/infected mothers wererecruited. HBsAg was positive in 8 children, anti-HBs in 37, andanti-HBc in 4 children. Seventy-three percent of children had beenvaccinated against HBV but only 81% had positive anti-HBs. Ofeighteen children who received hepatitis B vaccine and HBIg atbirth, none was infected. Six out of 25 children who received onlyhepatitis B vaccine were infected.Conclusion HBsAg, anti-HBs, and anti-HBc were positive in 14%,36%, and 7% of children of HBV carrier/infected mothers, respec-tively

Clinical manifestations of rotavirus diarrhea in the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta Teny Tjitrasari; Agus Firmansyah; Imral Chair
Paediatrica Indonesiana Vol 45 No 2 (2005): March 2005
Publisher : Indonesian Pediatric Society

Background Rotavirus is one of the most common cause of acutediarrhea among hospitalized and pediatric outpatients, especiallythose aged 6-24 months. Data of hospitalized children showed thatrotavirus causes severe diarrhea, but data of outpatient children inIndonesia, especially at Cipto Mangunkusumo Hospital Jakarta, islimited.Objective To characterize the clinical manifestations of rotavirusdiarrhea in the pediatric outpatient clinic at Cipto MangunkusumoHospital Jakarta.Methods This was a cross-sectional study, done in July 2003 â€“March 2004. Stool specimens were collected from patients aged6-24 months with diarrhea and tested for rotavirus by ELISA.Result Of the 98 children enrolled, 35 (35.7%) children excretedrotavirus. Rotavirus diarrhea was seen in 43.8% of children aged6-11 months, of whom 37.0% of them were undernourished. Maleswere affected 1.4 times as much as females. The clinical manifes-tations were passage of diarrheic stools more than 10 times a day(58.3%), mild-moderate dehydration (55.8%), cough (51.9%),rhinorhea (46.0%), vomiting (44.8%), fever (41.1%), yellow stools(38.9%), and mucus in the stool (20.0%). The highest prevalenceof rotavirus diarrhea was identified in the combination of diarrhea,fever, vomiting and cough/rhinorrhea (55.3%). Stool analysis re-vealed that the prevalence of rotavirus diarrhea among childrenwith fat malabsorption, lactose malabsorption, and stool leukocyteof +2 were 50.0%, 46.7% and 33.9%, respectively.Conclusion The prevalence of rotavirus diarrhea in the pediatricoutpatient clinic of Cipto Mangunkusumo Hospital, Jakarta was35.7%. The highest prevalence of rotavirus diarrhea was identifiedin the combination of diarrhea, fever, vomiting and cough/rhinorhea(55.3%)

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