What is included in the pharmacologic management of dehydration?

Updated: Dec 07, 2018
  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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Answer

Note the following:

  • Antidiarrheal agents are not recommended because of a high incidence of side effects including lethargy, respiratory depression, and coma.

  • Routine empiric antibiotics should be avoided and may worsen some specific diarrheal disease states (eg, hemolytic-uremic syndrome, Clostridium difficile).

  • Over-the-counter antiemetics are not recommended due to side effects including drowsiness and impaired oral rehydration.

  • In a study of 170 children aged 3 months to 5 years with acute diarrhea with vomiting and some dehydration, those who received treatment with a single dose of oral ondansetron (n = 85) and standard dehydration protocols showed faster rehydration, fewer vomiting episodes, and better caregiver satisfaction than those who were administered placebo and standard management of dehydration (n = 85). [21]

  • In an emergency department study, ondansetron has been shown to decrease likelihood of vomiting, increase oral intake, and decrease emergency department length of stay but has not shown significant effects on hospitalization rates or long-term outcomes. [22]

  • In a more recent study of 1313 Italian children with acute gastroenteritis, investigators found that in children for whom initial oral rehydration failed, a single oral dose of ondansetron reduced the need for intravenous hydration as well as the percentage of those who continued to vomit. [23] In comparison, domperidone was ineffective for symptomatic relief of vomiting during acute gastroenteritis.

  • Dimenhydrinate, although used in Europe and Canada, has not been found to improve oral rehydration. [24]


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