Antiemetics for Reducing Vomiting Related to Acute Gastroenteritis in Children and Adolescents

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. This review was selected for the TREKK Evidence Repository on gastroenteritis.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Anti-sickness medication for vomiting in acute stomach upsets in children

Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children with acute gastroenteritis can be problematic and there is lack of agreement among clinicians on the indications for the use of antiemetics. There have also been concerns expressed about apparently unacceptable levels of side effects with some of the older generation of antiemetics. The small number of included trials provided evidence which appeared to favour the use of antiemetics over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. A single oral dose of ondansetron given to children with mild to moderate dehydration can control vomiting, avoid hospitalization and intravenous fluid administration which would otherwise be needed. There were no major side effects other than a few reports of increased frequency of diarrhea.

Authors’ Conclusions:

Oral ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous ondansetron and metoclopramide reduced the number of episodes of vomiting and hospital admission, and dimenhydrinate as a suppository reduced the duration of vomiting.

Check Out the Full Cochrane Systematic Review Below:

Fedorowicz, Z., Jagannath, V.A., Carter, B. (2011). Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev, 9, CD005506. doi: 10.1002/14651858.CD005506.pub5

Did You Like the TREKK Gastroenteritis Video: My Child is Vomiting and Has Diarrhea?

This video is part of the Canadian Institutes of Health Research IHDCYH Talks video competition. If you liked the video, please log in to YouTube and give the video a thumbs up to support our work!

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.

Oral Versus Intravenous Rehydration for Treating Dehydration Due to Gastroenteritis in Children

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. This review was selected for the TREKK Evidence Repository on gastroenteritis.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Children with dehydration due to gastroenteritis need to be rehydrated, and this review did not show any important differences between giving fluids orally or intravenously

Dehydration is when body water content is reduced causing dry skin, headaches, sunken eyes, dizziness, confusion, and sometimes death. Children with dehydration due to gastroenteritis need rehydrating either by liquids given by mouth or a tube through the nose, or intravenously. The review of 17 trials (some funded by drug companies) found that the trials were not of high quality; however the evidence suggested that there are no clinically important differences between giving fluids orally or intravenously. For every 25 children treated with fluids given orally, one child would fail and require intravenous rehydration. Further, the results for low osmolarity solutions, the currently recommended treatment by the World Health Organization, showed a lower failure rate for oral rehydration that was not significantly different from that of intravenous rehydration. Oral rehydration should be the first line of treatment in children with mild to moderate dehydration with intravenous therapy being used if the oral route fails. The evidence showed that there may be a higher risk of paralytic ileus with oral rehydration while intravenous therapy carries the risk of phlebitis (ie inflammation of the veins).

Authors’ Conclusions:

Although no clinically important differences between oral rehydration therapy (ORT) and intravenous rehydration therapy (IVT), the ORT group did have a higher risk of paralytic ileus, and the IVT group was exposed to risks of intravenous therapy. For every 25 children (95% CI 14 to 100) treated with ORT one would fail and require IVT.

Check Out the Full Cochrane Systematic Review Below:

Hartling, L., Bellemare, S., Wiebe, N., Russell, K., Klassen, T.P., Craig, W. (2006). Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev, 3, CD004390. doi: 10.1002/14651858.CD004390.pub2

Did You Like the TREKK Gastroenteritis Video: My Child is Vomiting and Has Diarrhea?

This video is part of the Canadian Institutes of Health Research IHDCYH Talks video competition. If you liked the video, please log in to YouTube and give the video a thumbs up to support our work!

________________________________________________________________

This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.