Pediatric Vomiting & Diarrhea | The EM & Acute Care Course

Pediatric Vomiting & Diarrhea by Ken Milne, MD
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Key Points and Recommendations
1. Oral rehydration therapy is comparable to intravenous fluids in children with mild to moderate dehydration.
2. Commercial electrolyte solutions vary widely in the composition and may lack enough sodium for dehydration.
3. Use of ondansetron can reduce failure rates in ORT patients.
4. Ondansetron does not increase the QTc on electrocardiograms in children.
5. More severe dehydration and higher triage scores are associated with ORT failure.
6. Starvation ketosis is not associated with increased failure in ORT.
7. Family members prefer IVF or ORT.
8. Most clinicians do not consider nasogastric rehydration therapy in dehydrated children.
9. IVF with dextrose does not change clinical outcomes compared to electrolyte only IVF therapy.
10. Ondansetron prescriptions do not impact return visits to the ED.
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#pediatric #vomiting #diarrhea

[@NN-rn1oz]

Many kids come to the ED with vomiting. Most of them respond well to a single dose of oral ondansetron and oral progression, and are discharged as soon as they tolerate PO. As such, most are sent home without a blood workup. I sometimes wonder if this is good enough to rule out DKA and other important differentials? Common sense says yes, but it would be nice to have some hard evidence to back it up.

[@markmann6796]

Thank you. Excellent presentation. As an ED physician AND family medicine physician, I am continually frustrated by kids sent over from the various outpatient settings “for some IV fluids”.
The child gets their IV rehydration and guess what…they improve. So we ingrain in the parents’ thinking that a little vomiting or retching immediately warrants IV fluids.
Likewise, and even in adults now, we attempt to micromanage to the inth degree the composition of rehydration fluids. Madison Avenue loves us for it, but keeping it simple always wins the day.
Again, thank you.

[@edreesalqutel8002]

Nice work....تم