Kamis, 09 September 2010

Kejang Demam Sederhana dan Kompleks


KEJANG DEMAM SEDERHANA
Dasar diagnosa :
Kejang demam dengan frekuensi kejang tidak lebih dari 1 kali dalam 24 jam, kejang bersifat umum, lama kejang <15 menit dan tidak ada kelainan neurologis sebelum dan sesudah kejang.
Pengobatan dan tindak lanjut :
-          semua penderita yang datang dalam keadaan kejang diatasi dengan diazepam
-          pemberian antipiretik dan terapi kausal sesuai penyebab panas
-  suhu rektal ³ 39,50C
-  kejang berulang             
-   bila suhu rektal <39,50C, penderita dipulangkan dengan  dibekali obat antipiretik dan antikonvulsan diazepam oral/rektal pengobatan intermiten
-          nasehat : bila kejang lagi, kembali ke rumah sakit



KEJANG DEMAM KOMPLEKS

Dasar diagnosa :
Kejang demam dengan lama kejang >15 menit, kejang fokal atau kejang umum dengan frekuensi > 1 kali dalam 24 jam.
Pengobatan dan tindak lanjut sesudah kejang dapat diatasi :
Tentukan apakah perlu pengobatan rumat atau intermiten
-          bila anak dengan kejang lama diberi kortikosteroid sampai 12 jam bebas kejang
-          beri antipiretik dan antibiotika sesuai dengan penyebab naiknya suhu badan
  1. antipiretik bila panas ( parasetamol/ibuprofen )
-       parasetamol : 10 – 15 mg/kgBB/kali (4 kali pemberian)
-       Ibuprofen : 10 mg/kgBB/kali (3 kali pemberian)

  1. Obat terusan fenobarbital (3 –5 mg/kgBB/hari) atau asam valproat (10 – 40 mg/kgBB/hari) diberikan bila terdapat faktor resiko dibawah ini :
-  terdapat riwayat kejang tanpa demam pada orang tua atau saudara kandung
-  terdapat defisit neurologis sebelum dan sesudah kejang yang bersifat sementara atau menetap (palsi serebralis, retardasi mental, dan mikrosefali)
-  terdapat kejang fokal
-  lama kejang lebih dari 15 menit
-  kejang Berulang                                                           


  1. Obat Intermiten :
-       diazepam oral : 0,3 –0,5 mg/kgBB/hari setiap 8 jam pada saat demam
-       diazepam rectal : 0,5 mg/kgBB/kali (3 kali pemberian)

-          Pemakaian fenobarbital setiap hari dapat menimbulkan gangguan prilaku dan kesulitan belajar.
Pemakaian asam valproat pada usia kurang 2 tahun dapat menyebabkan gangguan fungsi hati, bila perlu pemeriksaan SGOT dan SGPT setelah 2 minggu,1 bulan kemudian 3 bulan.

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