A supplementary home dose of oral ondansetron given in anticipation of recurrent emesis in paediatric acute gastroenteritis
Abstract
You are a physician working in a paediatric emergency department (ED) in a large urban hospital. A two-year-old boy presents with a recent history of fever, emesis and abdominal pain. After examining him, you diagnose him with acute gastroenteritis and give him a 2 mg oral dose of ondansetron. Thirty minutes later, his symptoms have subsided and he is tolerating oral fluids. His parents ask you if they can go home with a ‘back-up’ dose of ondansetron in case his symptoms recur. What do you do? Acute gastroenteritis affects approximately 16 million children <5 years of age annually in the United States and accounts for roughly three million physician visits (1). The typical presentation includes acute onset of fever, abdominal cramps, emesis and diarrhea (2). Viruses are the most common cause, although bacteria and parasites are also implicated (3). In most cases, acute gastroenteritis is self-limited and does not require pharmacotherapy (4). Increased morbidity typically results from dehydration and electrolyte imbalances (5). Oral rehydration therapy and correction of electrolyte imbalances are the most important steps in management (5). In the United States, approximately 220,000 children <5 years of age are hospitalized annually for treatment of dehydration (1), with comparable rates in Canada (6). Rotavirus, the most common cause of severe gastroenteritis, is estimated to have a societal cost of $1 billion annually (7). The development and implementation of a rotavirus…
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