Choosing Wisely:

Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children.

Rationale and Comments: Many children who come to the emergency department with dehydration require fluid replacement. To avoid the pain and potential complications of an IV catheter, it is preferable to give these fluids by mouth. Giving a medication for nausea may allow patients with nausea and vomiting to accept fluid replenishment orally. This strategy can eliminate the need for an IV. It is best to give these medications early during the emergency department visit, rather than later, in order to allow time for them to work optimally.
Sponsoring Organizations:
  • American College of Emergency Physicians
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Pediatric
  • Emergency medicine
  • References: • Szajewska H, Gieruszcak-Bialek D, Dylag M. Meta-analysis: ondansetron for vomiting in acute gastroenteritis in children. Aliment Pharmacol Ther. 2007;25:393-400.
    • Roslund G, Hepps T, McQuillen K. The role of oral ondanestron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial. Ann Emerg Med. 2008;52(1); 22-9.
    • 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 System Rev. 2006;19(3):CD004390.

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