Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Do We Give Kids IV Fluids Too Freely?

By Landon Jones, MD and Richard M. Cantor, MD, FAAP, FACEP | on November 23, 2021 | 0 Comment
Kids korner
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

Question: In light of the Choosing Wisely campaign regarding oral antiemetic medications in children with acute gastroenteritis, does the literature suggest that we administer IV fluids too freely?

You Might Also Like
  • How Commonly Do Kids With Acute Appendicitis Present With Diarrhea?
  • Should You Give Constipated Kids an Enema or PEG Therapy?
  • Will IV Fluids Improve Lumbar Puncture Success?
Explore This Issue
ACEP Now: Vol 40 – No 11 – November 2021

A 2021 study by Freedman et al evaluated 1,415 children ages 3–48 months.1 The study was a preplanned secondary analysis of two multicenter pediatric ED studies—one in Canada and one in the United States. These studies were performed by Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) and included six sites in Canada and 10 sites in the United States. The initial study protocols were both prospective randomized trials evaluating probiotics and acute gastroenteritis (AGE). The authors incorporated a preplanned secondary analysis of these studies with a primary outcome of evaluating return visits within seven days in patients who received oral antiemetics. Secondary outcomes evaluated IV insertion and hospitalization. Clinical dehydration scale scores were recorded and include characteristics of general appearance, eyes, mucous membranes, and tears.

ED and primary care revisits within seven days of enrollment did not differ (adjusted odds ratio [aOR], 0.72; 95 percent confidence interval [CI] 0.50–1.02). While the revisit odds were similar, IV placement for fluid administration was higher in the U.S. cohort compared to the Canadian cohort (aOR 17.0 percent vs 8.2 percent; difference 8.8 percent; 95 percent CI 5.2–12.4 percent). There was no difference in the proportion of children receiving IV rehydration in the seven days following the index visit and no difference in the requirement for hospitalization, suggesting that the administration of oral antiemetics did not mask significant dehydration requiring IV fluid administration. Ondansetron was the antiemetic of choice in this study. This study suggests that U.S. pediatric emergency departments more liberally administer parenteral IV fluids and that resource allocation may be better utilized elsewhere initially with a trial of oral antiemetics for AGE without harming patient outcomes.

On a similar note, a 2016 meta-analysis by Tomasik et al further evaluated the effects of oral antiemetics on AGE outcomes in children.2 Ondansetron was the antiemetic evaluated in this study and compared to placebo. The study included 10 randomized controlled trials with 1,215 total patients. Ondansetron increased the likelihood that vomiting would cease at one hour (relative risk [RR], 1.49; 95 percent CI, 1.17–1.89). Ondansetron reduced the risk of failure of oral rehydration therapy (RR, 0.5; 95 percent CI, 0.37–0.69) and increased the intake of oral rehydration therapy at one hour and four hours after administration. A trial of oral ondansetron for AGE reduced the risk of hospitalization (RR, 0.53; 95 percent CI, 0.29–0.97) and demonstrated a reduction in the risk of need for IV placement for fluids (RR, 0.45; 95 percent CI, 0.31–0.63). Compared to placebo, there were no differences in return visits to the emergency department (RR, 1.14; 95 percent CI, 0.72–1.80), again suggesting that it does not appear to harm care.

Summary

Oral antiemetic treatment should be trialed first in children with AGE and mild-to-moderate dehydration before IV placement for IV fluid administration. This is consistent with the ACEP Choosing Wisely initiative.

Pages: 1 2 | Single Page

Topics: Acute GastroenteritisDehydration

Related

  • Balanced Fluids Better than Saline for IV Hydration

    March 6, 2018 - 0 Comment
  • Treatment for Acute Gastroenteritis, Acute Epididymitis in Pediatric Patients

    April 11, 2017 - 0 Comment
  • ACEP Reviews Guidelines on Education, Dehydration, Spinal Motion Restriction

    April 10, 2017 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

About the Authors

Landon Jones, MD

Dr. Jones is associate professor and pediatric emergency medicine fellowship director at the University of Kentucky Department of Emergency Medicine & Pediatrics in Lexington, Kentucky.

View this author's posts »

Richard M. Cantor, MD, FAAP, FACEP

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.

View this author's posts »

No Responses to “Do We Give Kids IV Fluids Too Freely?”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603