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You may already love ondansetron, but consider using it ORALLY followed by PO hydration in children with vomiting.
- Improve ORT success
- Decrease IV placements
- Decrease admission rates
- NOT cause any significant difference in the number of missed serious alternate diagnoses
The size of the study that showed this: N of just under 35,000.
But don't skimp on dosing. The dose is 0.1 - 0.15mg/kg, and you don't reach a max until 8mg. To put this in perspective, a scrawny 115lb (about 53kg) middle school tennis player would get 8mg, an initial dose often reserved for chemo patients in the adult ED.
References
Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK. Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? Ann Emerg Med. 2010 May;55(5):415-22. Epub 2010 Jan 19.