scholarly journals An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate

2021 ◽  
Vol 4 (1) ◽  
pp. 023-026
Author(s):  
D’Sa Saskia ◽  
Hussain Ahad ◽  
Hussain Mushtaq ◽  
Afridi Zahir ◽  
Twomey John ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Oral Intake ◽  
Admission Rate ◽  
Cost Effective ◽  
Oral Rehydration Therapy ◽  
University Hospital ◽  
Oral Hydration ◽  
Effective Measure ◽  
Oral Rehydration ◽  
Admission Rates

Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital. The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.

scholarly journals The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heewon Yang ◽  
Woochan Jeon ◽  
Yura Ko ◽  
Sooin Jeong ◽  
Jisook Lee
Keyword(s):  
Observational Study ◽  
Acute Gastroenteritis ◽  
Qt Interval ◽  
Pediatric Emergency ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Cardiac Complications ◽  
Oral Rehydration ◽  
The Mean ◽  
Oral Ondansetron

Abstract Background In mildly to moderately dehydrated patients with acute gastroenteritis (AGE), oral rehydration therapy (ORT) is the treatment of choice. Though ondansetron is a very effective antiemetics and leads to succeed ORT, there have been reports QT prolongation in patients using it. We investigated the effect of oral ondansetron on QT interval in mildly to moderately dehydrated children with AGE. Methods This retrospective observational study was conducted in a single pediatric emergency department (ED) of a tertiary university hospital. We collected the medical records of patients with a primary diagnosis of AGE who received oral ondansetron and underwent an electrocardiogram between January 2017 and June 2018. A pediatric emergency physician calculated the corrected QT interval (QTc) by Bazett’s method, and the calculations were reviewed by a pediatric cardiologist. QTc values before (preQTc) and after (postQTc) ondansetron administration were analyzed. ΔQTc was calculated as the change from preQTc to postQTc. We also investigated any cardiac complications from oral ondansetron. Results Total 80 patients were included. The mean age of the patients was 53.31 ± 32.42 months, and 45% were male. The mean dose of oral ondansetron was 0.18 ± 0.04 mg/kg. The mean interval from administration of ondansetron to performance of the electrocardiogram was 65 ± 26 min. The mean preQTc was 403.3 ± 24.0 ms, and the mean postQTc was 407.2 ± 26.7 ms. Two patients had a preQTc ≥460 ms, and one patient had a postQTc ≥460 ms. ΔQTc was ≥30 ms in seven patients (8.8%). No ΔQTc was ≥60 ms. No pre- or postQTc was ≥500 ms. No patient had a fatal cardiac arrhythmia after taking ondansetron. Conclusion Oral administration of a single dose of ondansetron in children with AGE did not cause high-risk QTc prolongation or fatal arrhythmia.

Dizziness While Traveling

2018 ◽  
pp. 12-15
Author(s):  
Jacqueline Paulis
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Physical Examination ◽  
Oral Intake ◽  
Oral Rehydration Therapy ◽  
Oral Rehydration ◽  
Glucose Test ◽  
Oral Rehydration Salts

Dizziness has a broad differential diagnosis in any setting. As a result, history and physical examination are critical in assessing cardiovascular, metabolic, central nervous system, and other acute causes. In the setting of dehydration, oral rehydration therapy is generally a safe and effective method of treatment, especially in underresourced areas. This chapter examines a case in which a patient presents with dizziness following cramping, abdominal pain, nausea, and decreased oral intake. Results from a glucose test are normal. Given the symptoms and lack of availability of imaging services, the author address the diagnosis of dehydration and discusses oral rehydration therapy and oral rehydration salts.

scholarly journals LO80: Ondansetron administration to non-dehydrated children with acute gastroenteritis-associated vomiting, in emergency departments in Pakistan: a randomized, blinded, phase 3, superiority trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S35
Author(s):  
S. Freedman ◽  
S. Soofi ◽  
A. Willan ◽  
S. Williamson-Urquhart ◽  
N. Ali ◽  
...  
Keyword(s):  
Treatment Group ◽  
Acute Gastroenteritis ◽  
Oral Rehydration Therapy ◽  
Fluid Administration ◽  
Double Blind ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Intravenous Fluid Administration ◽  
Superiority Trial ◽  
Randomization Scheme

Introduction: In high-income countries, vomiting often impedes oral rehydration therapy, leading to intravenous rehydration fluid administration to children with acute gastroenteritis. Ondansetron administration reduces vomiting and intravenous fluid administration in this population. We evaluated whether ondansetron is similarly effective when employed in Pakistan. Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department-based, randomized trial, we recruited children aged 0·5 to 5·0 years, without dehydration, who had diarrhea and 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), via an internet-based randomization service, using a stratified, variable block randomization scheme, to receive a single dose of oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 ml/kg over 4 hours of an isotonic fluid) within 72 hours of randomization. All randomized children were analysed. Results: From July 3, 2014, to January 12, 2017, 626 children were randomized. Intravenous rehydration was provided to 10.8% (34/314) and 10.3% (27/312) of children administered placebo and ondansetron, respectively (OR: 0.946; 95% CI: 0.564, 1.587; P=0.834). A regression model fitted with treatment group and adjusted for antiemetic administration and vomiting frequency in the preceding 24 hours, yielded similar results; OR=0.952; 95% CI: 0.570, 1.589; P=0.850. There was no evidence of interaction between treatment group and age (P=0.974), 3 diarrheal stools in the preceding 24 hours (P=0.983) or 3 vomits in the preceding 24 hours (P=0.554). During the 4-hour study observation period, 24.0% (75/314) and 19.6% (61/312) of children in the placebo and ondansetron groups vomited, respectively; OR: 0.774; 95%CI: 0.528, 1.133; P=0.187. Conclusion: Ondansetron administration did not significantly reduce intravenous rehydration use, suggesting that in children without dehydration, ondansetron administration does not significantly alter the disease course and should not be administered to this group of children.

scholarly journals LO34: Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S19
Author(s):  
N. Poonai ◽  
E. Powell ◽  
D. Schnadower ◽  
T. Casper ◽  
C. Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
A Priori ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Knowledge Translation Strategies

Introduction: Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. A better understanding of the factors associated with IV rehydration is needed to inform knowledge translation strategies. Methods: This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3-48 months and reported > 3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a priori risk factors. Results: From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5-11.8); severe (OR: 45.9, 95% CI: 20.1-104.7), P < 0.001], ondansetron in the ED (OR: 1.8, CI: 1.2-2.6, P = 0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3-2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2-34.8), P < 0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3-7.4, P < 0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P < 0.001]. Conclusion: Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

scholarly journals 118 Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

2019 ◽  
Vol 24 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Naveen Poonai ◽  
Elizabeth C Powell ◽  
David Schnadower ◽  
Charlie Casper ◽  
Cindy Roskind ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Acute Gastroenteritis ◽  
Secondary Analysis ◽  
Oral Rehydration Therapy ◽  
The United States ◽  
Pediatric Emergency ◽  
Research Network ◽  
Oral Rehydration ◽  
Intravenous Rehydration ◽  
Knowledge Translation Strategies

Abstract Background Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. Objectives We sought to better understand the factors associated with IV rehydration in children with AGE in order to inform knowledge translation strategies. Design/Methods This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3–48 months and reported >3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a prioririsk factors. Results From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5–11.8); severe (OR: 45.9, 95% CI: 20.1–104.7), P<0.001], ondansetron in the ED (OR: 1.8, CI: 1.2–2.6, P=0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3–2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2–34.8), P<0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3–7.4, P<0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P<0.001]. Conclusion Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

scholarly journals Perceptions and practices of oral rehydration therapy among caregivers in Cork, Ireland

2017 ◽  
Vol 4 (10) ◽  
pp. 3536
Author(s):  
Kene E. Maduemem ◽  
Muhammad Rizwan ◽  
Nnaemeka Akubue ◽  
Ioana D. Maris
Keyword(s):  
Diarrhoeal Disease ◽  
Oral Rehydration Therapy ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cross Sectional ◽  
Oral Rehydration ◽  
Paediatric Department ◽  
Paediatric Outpatient ◽  
Study Population ◽  
Negative Perceptions

Background: The use of oral rehydration therapy (ORT) remains limited despite international guidelines for diarrhoeal disease management. This study was done to assess the perception and practice of ORT among caregivers in the management of diarrhoeal disease. Methods: A descriptive cross-sectional study was conducted in the Paediatric Department of Cork University Hospital, Ireland. The study population consisted of parents/guardians of children attending the Paediatric Day Ward or Paediatric Outpatient Department. A questionnaire consisting of 30 questions was originally designed by the first author to include all the study variables, and was given to the participants. Results: Out of 402 respondents, 76.6% (n=308) could describe diarrhoea correctly and perceived it as a serious illness. 81.3% (n=327) of participants knew about ORT but only 27.2% (n=89) agreed it was an ideal first line of management of diarrhoeal disease. Diarrhoeal episodes in the preceding 12 months were reported predominantly in children under the age of 5 years (p<0.001). Only 8.7% (n=17) of caregivers used ORT for diarrhoeal management. Conclusions: Poor uptake of ORT appears to be due to caregivers’ negative perceptions of ORT. This emphasizes the need for correct and adequate education. 

Preliminary Results on the Use of Oral Rehydration Fluid in the Form of Gelato for Rehydration of Patients at the Children’s Clinical University Hospital’s Emergency and Infectiology Units

2019 ◽  
Vol 800 ◽  
pp. 65-69
Author(s):  
Gunda Zvigule-Neidere ◽  
Arta Barzdina ◽  
Gunta Laizane ◽  
Inese Sviestina ◽  
Karlis Agris Gross
Keyword(s):  
Small Intestine ◽  
Acute Gastroenteritis ◽  
Oral Rehydration Solution ◽  
Oral Rehydration Therapy ◽  
Sweet Taste ◽  
Sodium Ions ◽  
Fluid Absorption ◽  
Oral Rehydration ◽  
Rehydration Solution ◽  
Further Development

Oral rehydration fluids (ORS) are used to reverse dehydration that, in case of children, mostly is due to acute gastroenteritis. The key of successful dehydration treatment is to replenish the lost water and electrolytes. This is best done by consuming oral rehydration solution, containing both salt and sugar. ORS enhances fluid absorption because sodium and glucose transport in the small intestine are coupled, and glucose promotes absorption of both sodium ions and water. Studies show that children refuse ORS due to its salty-sweet taste and unpalatability. To improve oral rehydration therapy, we hypothesized that freezing ORS containing a fruit/berry juice to a likeable texture in “gelato” form could promote oral rehydration. The results provide a basis for further development of the ORS gelato with attention to flavor, sweetness and texture.

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