Dehydration Medication

  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Mar 12, 2012
 

Antiemetic, Serotonin Antagonist

Class Summary

In a recent emergency department study, ondansetron was shown to decrease likelihood of vomiting, increase oral intake, and decrease emergency department length of stay.[13]

View full drug information

Ondansetron (Zofran)

 

Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin), and complete body radiotherapy.

Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Lennox H Huang, MD, FAAP  Associate Professor and Chair, Department of Pediatrics, McMaster University School of Medicine; Chief of Pediatrics, McMaster Children's Hospital

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, Canadian Medical Association, Ontario Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Krishnapriya R Anchala, MD, MS, FAAP  Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University

Krishnapriya R Anchala, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, and Ontario Medical Association

Disclosure: Nothing to disclose.

Dan L Ellsbury, MD  Consulting Staff, Pediatrix Medical Group of Iowa; Consulting Staff, Department of Pediatrics, Neonatology Intensive Care Unit, Mercy Medical Center of Des Moines

Dan L Ellsbury, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Caroline S George, MD  Associate Professor, Consulting Staff, Department of Pediatrics, Division of Critical Care Medicine, University of Minnesota Medical School

Caroline S George, MD is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD, FCCM  Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

  1. Bettari L, Fiuzat M, Shaw LK, Wojdyla DM, Metra M, Felker GM, et al. Hyponatremia and long-term outcomes in chronic heart failure--an observational study from the Duke Databank for Cardiovascular Diseases. J Card Fail. Jan 2012;18(1):74-81. [Medline].

  2. Guarner J, Hochman J, Kurbatova E, Mullins R. Study of outcomes associated with hyponatremia and hypernatremia in children. Pediatr Dev Pathol. Mar-Apr 2011;14(2):117-23. [Medline].

  3. Zaki SA, Mondkar J, Shanbag P, Verma R. Hypernatremic dehydration due to lactation failure in an exclusively breastfed neonate. Saudi J Kidney Dis Transpl. Jan 2012;23(1):125-8. [Medline].

  4. Arora SK. Hypernatremic Disorders in the Intensive Care Unit. J Intensive Care Med. May 16 2011;[Medline].

  5. [Guideline] Goldman RD, Friedman JN, Parkin PC. Validation of the clinical dehydration scale for children with acute gastroenteritis. Pediatrics. Sep 2008;122(3):545-9. [Medline].

  6. Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated?. JAMA. Jun 9 2004;291(22):2746-54. [Medline].

  7. Colletti JE, Brown KM, Sharieff GQ, Barata IA, Ishimine P. The Management of Children with Gastroenteritis and Dehydration in the Emergency Department. J Emerg Med. Apr 2 2009;[Medline].

  8. Parkin PC, Macarthur C, Khambalia A, Goldman RD, Friedman JN. Clinical and Laboratory Assessment of Dehydration Severity in Children With Acute Gastroenteritis. Clin Pediatr (Phila). Jun 1 2009;[Medline].

  9. Cheuvront SN, Kenefick RW, Montain SJ, Sawka MN. Mechanisms of aerobic performance impairment with heat stress and dehydration. J Appl Physiol. Dec 2010;109(6):1989-95. [Medline].

  10. Steiner MJ, Nager AL, Wang VJ. Urine specific gravity and other urinary indices: inaccurate tests for dehydration. Pediatr Emerg Care. May 2007;23(5):298-303. [Medline].

  11. Atherly-John YC, Cunningham SJ, Crain EF. A randomized trial of oral vs intravenous rehydration in a pediatric emergency department. Arch Pediatr Adolesc Med. Dec 2002;156(12):1240-3. [Medline].

  12. Hartling L, Bellemare S, Wiebe N, Russell K, Klassen TP, Craig W. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev. Jul 19 2006;3:CD004390. [Medline].

  13. [Best Evidence] Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. Apr 20 2006;354(16):1698-705. [Medline].

  14. Uhlig U, Pfeil N, Gelbrich G, et al. Dimenhydrinate in children with infectious gastroenteritis: a prospective, RCT. Pediatrics. Oct 2009;124(4):e622-32. [Medline].

  15. Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. May 18 2000;342(20):1493-9. [Medline].

  16. Bellemare S, Hartling L, Wiebe N, et al. Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials. BMC Med. Apr 15 2004;2:11. [Medline].

  17. Bender BJ, Ozuah PO, Crain EF. Oral rehydration therapy: is anyone drinking?. Pediatr Emerg Care. Sep 2007;23(9):624-6. [Medline].

  18. Bhatnagar S, Bahl R, Sharma PK, et al. Zinc with oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children: a randomized controlled trial. J Pediatr Gastroenterol Nutr. Jan 2004;38(1):34-40. [Medline].

  19. Choice Study Group. Multicenter, randomized, double-blind clinical trial to evaluate the efficacy and safety of a reduced osmolarity oral rehydration salts solution in children with acute watery diarrhea. Pediatrics. Apr 2001;107(4):613-8. [Medline].

  20. Dale J. Oral rehydration solutions in the management of acute gastroenteritis among children. J Pediatr Health Care. Jul-Aug 2004;18(4):211-2. [Medline].

  21. Duggan C, Fontaine O, Pierce NF, et al. Scientific rationale for a change in the composition of oral rehydration solution. JAMA. Jun 2 2004;291(21):2628-31. [Medline].

  22. Duggan C, Refat M, Hashem M, et al. How valid are clinical signs of dehydration in infants?. J Pediatr Gastroenterol Nutr. Jan 1996;22(1):56-61. [Medline].

  23. Duke T, Molyneux EM. Intravenous fluids for seriously ill children: time to reconsider. Lancet. Oct 18 2003;362(9392):1320-3. [Medline].

  24. Fonseca BK, Holdgate A, Craig JC. Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med. May 2004;158(5):483-90. [Medline].

  25. Gorelick MH, Shaw, KN, Murphy, KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;May;(5):99:E6. [Medline].

  26. Holliday M. The evolution of therapy for dehydration: should deficit therapy still be taught?. Pediatrics. Aug 1996;98(2 Pt 1):171-7. [Medline].

  27. Holliday MA, Friedman AL, Segar WE, et al. Acute hospital-induced hyponatremia in children: a physiologic approach. J Pediatr. Nov 2004;145(5):584-7. [Medline].

  28. Holliday MA, Friedman AL, Wassner SJ. Extracellular fluid restoration in dehydration: a critique of rapid versus slow. Pediatr Nephrol. May 1999;(4):292-7. [Medline].

  29. Hoorn EJ, Geary D, Robb M, et al. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics. May 2004;113(5):1279-84. [Medline].

  30. King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. Nov 21 2003;52(RR-16):1-16. [Medline].

  31. Miyasaka K, Shimizu N, Kojima J. Recent trends in pediatric fluid therapy. Methods Find Exp Clin Pharmacol. May 2004;26(4):287-94. [Medline].

  32. Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol. Aug 4 2005;[Medline].

  33. Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics. Feb 2003;111(2):227-30. [Medline].

  34. Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis?. Pediatrics. Sep 2005;116(3):e343-7. [Medline].

  35. Murphy C, Hahn S, Volmink J. Reduced osmolarity oral rehydration solution for treating cholera. Cochrane Database Syst Rev. 2004;CD003754. [Medline].

  36. Nager AL, Wang VJ. Comparison of nasogastric and intravenous methods of rehydration in pediatric patients with acute dehydration. Pediatrics. Apr 2002;109(4):566-72. [Medline].

  37. Nalin DR, Hirschhorn N, Greenough W, et al. Clinical concerns about reduced-osmolarity oral rehydration solution. JAMA. Jun 2 2004;291(21):2632-5. [Medline].

  38. Ozuah PO, Avner JR, Stein RE. Oral rehydration, emergency physicians, and practice parameters: a national survey. Pediatrics. Feb 2002;109(2):259-61. [Medline].

  39. Phin SJ, McCaskill ME, Browne GJ, Lam LT. Clinical pathway using rapid rehydration for children with gastroenteritis. J Paediatr Child Health. Jul 2003;39(5):343-8. [Medline].

  40. Playfor SD. Hypotonic intravenous solutions in children. Expert Opin Drug Saf. Jan 2004;3(1):67-73. [Medline].

  41. Reid SR, Bonadio WA. Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis. Ann Emerg Med. Sep 1996;28(3):318-23. [Medline].

  42. Santosham M, Keenan EM, Tulloch J, et al. Oral rehydration therapy for diarrhea: an example of reverse transfer of technology. Pediatrics. Nov 1997;100(5):E10. [Medline].

  43. Sarnaik AP, Meert K, Hackbarth R, Fleischmann L. Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy. Crit Care Med. 1991;Jun;19(6):758-62. [Medline].

  44. [Best Evidence] Spandorfer PR, Alessandrini EA, Joffe MD, et al. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. Feb 2005;115(2):295-301. [Medline].

  45. Wathen JE, MacKenzie T, Bothner JP. Usefulness of the serum electrolyte panel in the management of pediatric dehydration treated with intravenously administered fluids. Pediatrics. Nov 2004;114(5):1227-34. [Medline].

 
Previous
Next
 
Table 1. Clinical Findings of Dehydration
Symptom/SignMild DehydrationModerate DehydrationSevere Dehydration
level of consciousnessAlertLethargicObtunded
Capillary refill*2 s2-4 s>4 s, cool limbs
Mucous membranesNormalDryParched, cracked
TearsNormalDecreasedAbsent
Heart rateSlightly increasedIncreasedVery increased
Respiratory rate/pattern*NormalIncreasedIncreased and hyperpnea
Blood pressureNormalNormal, but orthostasisDecreased
PulseNormalThreadyFaint or impalpable
Skin turgor*NormalSlowTenting
FontanelNormalDepressedSunken
EyesNormalSunkenVery sunken
Urine outputDecreasedOliguriaOliguria/anuria
* Best indicators of hydration status[6]
Table 2. Estimated Fluid Deficit
SeverityInfants (weight < 10 kg)Children (weight >10 kg)
Mild dehydration5% or 50 mL/kg3% or 30 mL/kg
Moderate dehydration10% or 100 mL/kg6% or 60 mL/kg
Severe dehydration15% or 150 mL/kg9% or 90 mL/kg
Table 3. Composition of Appropriate Oral Rehydration Solutions
SolutionCarbohydrate (g/dL)Sodium (mEq/L)Potassium (mEq/L)Base (mEq/L)Osmolality
Pedialyte2.5452030250
Infalyte3502530200
Rehydralyte2.5752030310
WHO/UNICEF*2902030310
* World Health Organization/United Nations Children's Fund
Table 4. Composition of Inappropriate Oral Rehydration Solutions
SolutionCarbohydrate (g/dL)Sodium (mEq/L)Potassium (mEq/L)Base (mEq/L)Osmolality
Apple juice120.4260700
Ginger ale93.50.13.6565
Milk4.9223630260
Chicken broth0233330
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.