How to administer medicine to children and infants

The following are questions that are often asked by parents of children and babies in Panti Rapih Hospital Pharmacy:


What do doctors pay attention to when giving medicine to babies or children?

When prescribing medicines for babies and children, the doctor will see:

  1.     Diagnosis of disease based on physical and laboratory examinations (if needed).
  2.     Baby age. The smaller the baby's age, the more drugs that may not be given.
  3.     Baby weight. The dosage of the drug is given based on the weight of the baby so that weighing the body is very important.

 

What if your baby's medicine is still left over, can it be given back if one day he experiences the same disease?
Depending on the type of drug, if:

  1. Antibiotics. Don't give it! Whatever the shape is either syrup or powder. Antibiotics should be spent or according to doctor's instructions.
  2. Concoction. Both syrup and powder should not be given, it is feared there are types of drugs that cannot be consumed again.
  3. Syrup medicine. May be given, for example febrifuge, cough, runny nose, and others.
  4. Powdery, such as seizure medication or other emergency drugs, can be given as long as the drug condition does not change, either color or texture (clumping / not). As well, the weight or age of the baby is not much different when the drug is given.


How long can the syrup medicine last after the packaging is opened?
Actually there is no definite time. The mother should check the condition and expiration date of the drug again.

What is the best method for storing residual syrup?

  1. Close the medicine bottle tightly, wash / wipe with warm water to remove the remaining drugs outside the bottle.   
  2. Place it in the place indicated on the medicine package. If requested in a refrigerator, preferably not in the freezer, place it in a separate closed container so that it is not contaminated with vegetables or other ingredients in the refrigerator.
  3. Store in a room temperature that is maintained (26-27 degrees Celsius) and avoid direct sunlight.

Can your child be given medicine belonging to another baby or child?
See the little one's condition. The principle may be, limited drugs for first aid, such as fever, provided the age or weight between one baby to another is not much different, can use the same usage rules. But if you are different in weight or age, ask your pharmacist. For drugs other than febrifuge, it is recommended to see a doctor so that the treatment is in accordance with the conditions and dosage needed.

Which is better, a febrifuge drug in the paracetamol or ibuprofen group?
Both are the same, but sometimes some feel more suitable using paracetamol than ibuprofen or vice versa.
But usually for children who have a history of convulsions or heat that is difficult to go down, the doctor may combine 2 types of febrifuge drugs that are given alternately.
For cases of suspected dengue hemorrhagic fever, administration of paracetamol is a choice. Due to the administration of ibuprofen it is thought that it can lead to a decrease in platelet counts.

When can a re-fever lowering medication be given after the first administration?
Giving was repeated 4-6 hours after administration of the drug beforehand. If the heat is difficult to fall, the mother can give the baby to drink more and compress the body with warm water.

Which is better, a fever-lowering drug through the mouth or anus?
It's the same, but the drugs given through the anus react faster. But the gift is adjusted also with the complaints of the child. If the baby is vomiting, the drug will be administered through the anus. But if the baby has diarrhea, it will be more effective if the drug is given by mouth.

Can you stop giving antibiotics prematurely?
It may not be because it can cause resistance / resistance to germs. Mothers also cannot change their drinking rules, for example: 4x1 becomes 3x1 because each antibiotic has its own working period. If your child missed 1x while taking antibiotics, Mother still gave it according to the instructions for use with a shorter interval, for example: the baby should take medicine at 9 but accelerated to 6 o'clock.

Is it true that giving antibiotics to babies can result in yellow teeth when a child is big?
When Mother is still small, there is a type of Tetracycline antibiotic. Well, this type can cause yellow teeth when the little one is big. But don't worry because it's rarely used now.

Is patent medicine better than generic drugs?
Between patents and generics have the same quality. Because it has the same content. Patent drugs are usually far more expensive than generic drugs due to additional ingredients, packaging costs and promotional costs. But sometimes doctors prescribe patent drugs because there are several types of drugs that are not yet generic.

Is it possible for an allergic reaction to occur in a baby during administration? If yes, how are the characteristics?
Allergic reactions due to drug administration are very possible.

The characteristics that arise depend on what system is affected, for example:

  1.     Digestion, marked by babies experiencing nausea, vomiting until diarrhea.
  2.     Breathing, marked by the sound of grok-grok due to the production of excess mucus. You can even get short of breath.
  3.     Skin, red spots appear, itchy to blister.

This allergic reaction can arise immediately after the drug is given or even a few days later. So, mothers are advised to keep copies of recipes and receipts for your child's medication to find out which drugs cause allergic reactions. With any drug data that has been used, the mother can find out the medical history of your child as well.

What are the parents' actions if the baby has a drug allergic reaction?
The first thing to do is to stop using the drug to avoid more reaction.
Actions that can be done depend on complaints that arise, if:

  1. Light, limited to itchy and red-red, you can simply stop giving the drug and give topical medication to the affected area.
  2. Severe, such as vomiting, diarrhea to tightness, stop giving the drug immediately and take it to the nearest health center.

Can you increase / decrease drug dosage independently by parents?
We recommend that you consult a doctor, do not reduce / increase the dose independently. If overdose, can cause liver and kidney disorders in the long term. However, if the dosage is lacking, the drug cannot work optimally.

What if the baby vomits medicine?
If the medicine given is immediately vomited, you can give it again at the same dose. But if your little one vomits after 30 minutes, you don't need to repeat, because the intestine will absorb most of the medicine at 30-45 minutes after administration.

Contact your pediatrician if your child is vomiting back and forth. Giving a dose of medication that is too often can cause vomiting or diarrhea, especially in some types of antibiotics. If you have this, giving antibiotics can be done by injection.

Can you mix drugs, for example syrup mixed with powder?
You can, but you have to pay attention to the time of giving. Do not combine drugs that should be taken before meals with medication after meals.

Which is better, syrup or powder medicine?
It's the same, but if there are a lot of prescription drugs, for the sake of practicality, doctors usually prescribe concoction so that your child doesn't need to take many drugs.

Can you give medicine to babies by mixing with honey?
Children are often uncomfortable with the mostly bitter taste of the drug. To improve the taste, you should be able to give sugar water or pure honey. But sometimes it is feared that circulating honey is not necessarily good, high sugar levels can also cause coughing. If you have to give a bitter quail, you can ask for additional flavor neutralizers at the nearest pharmacy.

Can the baby drink milk immediately after taking medicine?
Depending on the type of drug. There are those who can, but there are also those who wait 30 minutes after administration of the drug, because there are certain drugs that are soluble in milk.

There are several drugs that can be given along with milk. For example, Lactobacillus powder preparations (which are commonly used to treat diarrhea in children). However, all milk must be taken so that the medication your child receives is in accordance with the dosage.

Easy tips for giving medicine to babies?

  1. Create a relaxed atmosphere, if your child likes to hear music then play music. Divert attention so that he doesn't know he will be given medicine.
  2. Avoid using loud sounds when giving medicine. Use soft tones and the mother relaxes.
  3. Position the baby with the head higher so that the drug does not enter the lungs. Generally, giving medicine to babies is more difficult, because he likes to rebel. So, the position of his body must be right. How? Your little one's lap, then arrange for her position to be half seated.

Note: Do not stretch the baby, because the drug can enter the lungs. Especially for babies, the liquid medicine should be given with a pipette. The baby can't swallow from a spoon! There is a trick so that the drug was really swallowed by the little one. For example, place the pipette in the corner of the baby's mouth, then slowly remove the drug. Place the tip of the pipette on the lower lip of the child, let the drug flow into the mouth.

Dysmenorrhea and Management

Dysmenorrhea (dysmenorrhea) comes from the ancient Greek word "dys" meaning difficult / painful, "meno" means month, "rrhea" means flow / flow. Then dysmenorrhea is defined as pain that occurs during menstruation. There are two types of dysmenorrhea, namely primary dysmenorrhea (menstrual pain without pelvic abnormalities) and secondary dysmenorrhea (menstrual pain accompanied by pelvic abnormalities).

Risk factors for dysmenorrhea include heavy menstruation, irregular menstrual cycles, age less than 30 years, sexual violence, first menstruation at <12 years of age, malnutrition, obesity, family history, and smoking.

Primary dysmenorrhea can occur due to excessive production of prostaglandin by the endometrium. The production of prostaglandin is affected by progesterone levels, which increase during or immediately after menstruation begins. This prostaglandin causes uterine contractions so that pain is felt during menstruation. Secondary dysmenorrhea can occur due to endometriosis, adenomyosis, polyps, tumors, infections, and attachments.

Dysmenorrhea occurs 6-12 months from the first menstruation, during the menstrual cycle, and lasts for 8 - 72 hours. Complaints related to dysmenorrhea are back and thigh pain, headaches, diarrhea, nausea and vomiting. There are also other complaints such as pain during intercourse, too much menstrual blood, bleeding after intercourse, and bleeding between menstrual schedules that should be.

The doctor will diagnose dysmenorrhea by asking about the characteristics of menstrual pain, history of infection or vaginal discharge, and family history; the doctor will also examine the pelvis and genital organs; if necessary, the doctor will perform transvaginal ultrasonography.

Other useful tests include a pregnancy test for human chorionic gonadotropin in the urine; vaginal and cervical swabs, complete blood count, erythrocyte sedimentation rate in urine, and urinalysis. Cervical cytology can also be done to get rid of malignancy. MRI can be used as a second-line diagnostic choice

The main therapy is non-steroidal anti-inflammatory drugs such as mefenamic acid and ibuprofen. Treatment must be carried out one to two days before the onset of menstruation and continue with a fixed schedule for two to three days. In addition, hormonal contraception can also be used as a treatment for dysmenorrhea. Other therapies other than medicines are exercise and warm compresses.

Reference
1. Obstetrics and gynecology. 3th. Baltimore, MD: Lippincott Williams & Wilkins; 2016
2. aafp.org/ Diagnosis and initial management of dysmenorrhea
3. PNPK. Management of Menstrual Pain in Endometriosis. 2013

Post-Flood Leptospirosis

Flood disasters at the peak of the Cempaka tropical cyclone in the Special Region of Yogyakarta (DIY) and southern East Java on Tuesday, November 28, 2017 were very alarming. Follow-up danger after the flood recedes is a deadly * leptospirosis disease. * Leptospirosis is a disease caused by infection with the bacteria Leptospira sp. which can be transmitted from animals to humans (zoonoses). What do we need to be aware of?

Leptospirosis was first reported in 1886 by Dr. Adolf Weil with symptoms of * high fever accompanied by several neurological symptoms and enlargement of the liver and spleen. * Disease with the above symptoms by Goldsmith 1887 referred to as Weil's Disease. In 1915 Dr. Inada succeeded in proving that "Weil's Disease" * was caused by the Leptospira icterohemorrhagiae bacteria. *

In 2016, leptospirosis cases in Indonesia reached 343 people, 47 people died and CFR (Case Fatality Rate) 13.70%, while in DIY with 17 cases, 6 died, * the CFR in DIY was very high, namely 35.29%. * At the age of more than 50 years the death reaches 56%. In some publications the mortality rate is reported to be between 3-54% depending on the organ system that is infected.

* Leptospirosis is a disease that can be transmitted through water (water borne disease). * Urine (urine) from individuals affected by this disease is the main source of transmission, both in humans and in animals. * Heavy rain will help spread this disease, especially in flooded areas. * Leptospirosis events in humans are found in sewer cleaning workers, * because the sewers are contaminated with Leptospira bacteria. * Leptospirosis can also affect children, who live * in a dense urban environment with many house mice hanging around. *

The incubation period of Leptospirosis in humans is 2-26 days. Leptospirosis infection has very varied manifestations and * sometimes asymptomatic, resulting in frequent misdiagnosis, especially in subclinical infections characterized by mild to severe flu. * Nearly 40% of patients exposed to asymptomatic infections * but positive serological examination. * Approximately 90% sufferers will experience mild yellow eyes and skin, while 5% yellow is heavy which is known as Weil disease. * Leptospira disease journey consists of 2 phases, * namely the septicemic and immune phases. * In the phase transition period for 1-3 days the patient's condition might look better.

* Septicemic phase is known as the initial phase or leptospiremic phase because bacteria can be isolated from blood, cerebrospinal fluid and most body tissues. * At this stage, patients will experience flu-like symptoms for 4-7 days, characterized by fever, cold, and weakness muscle. Other symptoms are sore throat, cough, chest pain, vomiting of blood, headache, fear of light, mental disorders, inflammation of the lining of the brain (meningitis), and * enlargement of the spleen and liver. * Immune phase is often called * second phase or leptospirurik due to circulating antibodies can be detected by isolation of germs from urine, * and may not be obtained from blood or cerebrospinal fluid. This phase occurs at 0-30 days due to the body's defense response to infection. Symptoms depend on disturbed organs such as the lining of the brain, liver, eyes or kidneys.

If the brain membrane is attacked, depression, anxiety and headache will occur. On examination the liver is found yellow skin, enlarged liver (hepatomegaly), and signs of coagulopathy. Lung disorders include coughing, coughing up blood, and difficulty breathing. Hematological disorders in the form of inflammation and enlargement of the spleen (splenomegaly). Cardiac abnormalities are characterized by heart failure or pericarditis. Aseptic meningitis is the most important clinical manifestation in the immune phase.

* Weil syndrome is a form of severe Leptospirosis characterized by yellow skin or eyes, kidney dysfunction, liver necrosis, lung dysfunction, and diathesis bleeding. * This condition occurs at the end of the initial phase and increases in the second phase, but can worsen at any time. Pulmonary manifestations include coughing, difficulty breathing, chest pain, coughing up blood, and respiratory failure. Patients with heavy yellow are more susceptible to kidney failure, bleeding, and cardiovascular collapse. * Severe cases with liver and kidney disorders result in deaths of 20-40%. *

Diagnosis Leptospirosis is usually * done by serological examination. * Antibodies can be found in the blood on the 5-7th day after the presence of clinical symptoms. In addition to serological examination, to confirm Leptospirosis infection is * Microscopic agglutination test (MAT). * Culture or observation of Leptospira bacteria under a microscope with a dark background is generally insensitive. In addition, a diagnosis can also be made by observing Leptospira bacteria in infected organ specimens, using immunofloresen.

Leptospirosis can be treated with antibiotics doxycycline, ampisillin, amoxicillin, erythromycin * and newer antibiotics. However, treatment delay, misdiagnosis, or the occurrence of Weil Syndrome, * can increase mortality or CFR (Case Fatality Rate). *

The floods due to the Cempaka tropical cyclone in the Special Region of Yogyakarta (DIY) must be anticipated as well as possible. * Not only with the reconstruction of buildings after the flood, but also increased awareness of the dangers of leptospirosis. *

May be useful

Yogyakarta, November 29, 2017
*) Secretary of IDI Kota Yogyakarta Branch, pediatrician at Yogyakarta Panti Rapih Hospital and Siloam Hospital @LippoPlaza, S3 S3 Alumni, WA: 081227280161,

e-mail: fxwikan_indrarto@yahoo.com

Stroke “Understanding and Recognizing”

Human Brain

The human brain is divided into 3 major parts, namely the right and left large brains and the cerebellum in the back, each part has its own function, the right cerebrum will supply the left side of the face, body and limbs and vice versa for the left cerebrum, while the cerebellum has the function of balance and coordination, the brain is an organ that is very sensitive and depends on the supply of oxygen and nutrients from the blood because the brain does not have the ability to store energy reserves, therefore the brain is supplied by 2 arteries (blood vessels that carry blood from the heart) which is large in the front and 1 artery in the back, these arteries will be interconnected at the base of the brain forming a circle of arteries ready to supply blood throughout the brain, the brain needs 50-60cc of blood every minute for every 100grams of tissue brain.

The brain tissue is encased by the lining of the brain consisting of 3 layers, while the brain tissue itself consists of the cortex which is on the outside and the sub cortex which is under the cortex, in this part of the cortex there is a center of movement, sensibility, sublime function (attention, language, memory, object recognition and executive function). The cortex network can function properly when the blood supply to the brain is in good condition.

Understand about stroke

Stroke is a function disorder of the brain, both only part or all parts of the brain caused by interference from the blood flow to the brain. This disruption of blood flow to the brain can be in the form of blockages in the brain's blood vessels or brain blood vessels that break or leak.

Stroke is a very important health problem, 1 in 6 people will experience a stroke, and stroke is the third highest cause of death after cancer and heart disease. Disabilities caused by stroke also have a major impact on the sufferer's personal, social and economic life.

Known as 2 types of strokes, namely stroke bleeding (hemorrhagic) and blockage stroke (infarction / non hemorrhagic), strokes blockage occurs because blood flow in the brain is blocked can occur because blood clots through narrowed blood vessels, while bleeding strokes occur due to blood vessels in the brain ruptured so that blood diverts out of the blood vessels and urges brain tissue. The incidence of blockage stroke is more than that of bleeding strokes.

Both blockage and bleeding strokes cause the supply of brain tissue to be disrupted, so that the nutrients and oxygen needed by brain tissue become reduced or exhausted, the brain tissue will lack energy or die, this is what triggers clinical manifestations in patients.

Recognizing Stroke

Disorders experienced by brain tissue will cause the appearance of clinical manifestations, clinical manifestations that occur are sudden due to blockage or rupture of blood vessels is also sudden. The manifestations experienced can be one or more of the following manifestations:

1. Impaired consciousness

A person who experiences a stroke can suddenly experience a disturbance of consciousness, starting to look sleepy until it cannot be awakened.

2. Sublime function disorders

Sublime functions are intellectual functions, which include attention, language, memory (memory), visuospatial (recognition of form and space) and executives (Decision making), Disturbance of sublime functions that occur due to stroke can affect 1 or more sublime functions above.

3. Weakness half body

This complaint is the most frequent and most remembered by the community, namely the weakness of half of the body that is sudden, weakness experienced has different degrees ranging from mild to unable to move at all

4. Half-body disturbance

The taste disorder can be various, but it is half the body, for example thick, thick, tingling, needles, half body pain

5. Pelo or perot

Pelo and perot is also a frequent symptom, weakness that occurs in the facial muscles side-by-side will cause the face to be attracted to the healthy side, this causes the face to appear perot as well as the weakness of the tongue muscles so that patients complain of pelo / slurred / celat

6. Spin dizziness or groggy

Spinning dizziness or nggliyer (feeling of floating, light, swaying) can be experienced both as the beginning of a stroke because blood flow in the cerebellum begins to decrease or because a stroke has occurred in the brain.

7. Sudden blindness

Sudden blindness is one of the manifestations of stroke, if there is a blood vessel disorder in the large brain in the back

Keep in mind that complaints - complaints that arise because of a stroke are always sudden or sudden, the complaint can only occur less than 24 hours or stay more than 7 days. If the complaint appears missing within 24 hours then what happens is a cursory stroke or called TIA (Transient Ischemic Atttack). TIA is a risk factor for stroke because it must be treated immediately.

The United States Government introduces its citizens to signs of stroke that must be recognized so that they can immediately ask for help, known as F.A.S.T (Face. Arm. Speech. Time)

Face: recognize the presence of perot on the face
Arm: Half of the body and limbs are difficult to move
Speech: Talk to pelo / cedhal / celat
Time: Immediately seek medical help

The results of stroke therapy are very dependent on time, which is meant here is the time from the onset of the attack to getting medical help (golden period), therefore if there are signs that as above sufferers must immediately be taken to the emergency department.

Trigger Finger – Causes of Hand Pain & Stiffness

Are your fingers stiff and sore if you bend them towards your palm? Maybe you suffer from a disease called Finger Trigger.

The movement of straight fingers points to something or bending towards the palm of the hand is done by a part of the muscle called the tendon (that is, the part of the muscle attached to the bone). In order to be in their respective places, the tendons are "held" by several sheaths called pulleys, which are shaped like a short tunnel


Cause

Under normal circumstances, the tendo is round or flat with a smooth and slippery surface so that it can move inside the pulley tunnel easily without obstacles. Trigger finger can occur if:

  •     Tendo swells and forms a lump called a nodule
  •     The sheath of the tendon (pulley) is thickened

Both of these conditions cause the tendon to be "pinched" by the pulley so that trigger finger occurs.
The exact cause of the trigger finger is unknown. However, trigger finger tends to be experienced by:

  • Pregnant woman or after childbirth
  • Menopausal women
  • Diabetes sufferers
  • Alcohol drinkers
  • Workers who do a lot of grasping movements


Symptoms

The symptoms of a trigger finger are pain and stiffness in the affected finger. Pain usually arises when the finger is bent or straightened, and is commonly experienced in the base of the finger. When the finger is bent or straightened it often feels the "cling" sensation on the finger. In more severe circumstances, the fingers cannot be straightened back after being bent without being helped straightened by the fingers of the other hand.

Trigger finger can hit each finger simultaneously or at different times. The most frequently affected finger is the thumb and middle finger.
Treatment

For early-stage trigger finger, taking anti-inflammatory medication can relieve pain and stiffness, but cannot cure it completely. Anti-inflammatory drug injections provide temporary relief (for about 3 months) but are at risk of causing tenderness if the injection is made of the tendo. A fragile tendon is at risk of breaking up.

Advanced trigger finger treatment, and relapse after being given an anti-inflammatory drug (either taken or injected), is an operation called release trigger finger.

This operation aims to open (divide) the sheath of the tendon (pulley) which thickens and "clamp" the tendon on the affected finger, so that the tendo can move freely again without causing pain. This is a small operation (a cut of about 1 cm) that can be done with local anesthesia, takes only about 10 minutes, and the patient does not need to stay in the hospital. Surgery on trigger finger ensures complete healing without the possibility of relapse.

For more information contact:

Orthopedic and Traumtoalogy Clinic
Panti Rapih Hospital
Jl. Cik di Tiro 30 Yogyakarta 55223
Tel: 0274 - 563333 ext 337, 339