Evaluating outcomes associated with a discharge action plan employing single-dose home use of ondansetron in patients with acute gastroenteritis

Abstract

Acute gastroenteritis accounts for 1–2 million annual pediatric emergency department visits in the US. The current literature supports the use of antiemetics, such as ondansetron, in the emergency department, reporting improved oral rehydration, cessation of vomiting, and reduction in the need for intravenous rehydration. However, there remains concern that using these agents may “mask alternative diagnoses” and negatively impact patient care. We present a case series of 29 patients who received a pediatric emergency department discharge action plan which allowed for a dose of ondansetron to be dispensed by the clinician at the time of discharge. Patients were instructed to administer the ondansetron at home for treatment of ongoing nausea and vomiting any time after 6 hours from the time of emergency department discharge. These patients were followed up at 3–5 days following discharge to assess for outcomes. Implications of this discharge action plan and future directions are discussed.

Heat stroke with bimodal rhabdomyolysis: a case report and review of the literature

“…Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy [5–7]. Rhabdomyolysis usually occurs in the acute phase of heat stroke.…”

A supplementary home dose of oral ondansetron given in anticipation of recurrent emesis in paediatric acute gastroenteritis

“…While a 2010 study found no change improvement in ED revisit rates after discharging patients home with a written prescription for ondansetron, the authors caution that they did not track the number of patients who actually filled their prescriptions (22). A home dose of ondansetron given to patients by the ED physician as part of discharge planning may TherapeuTic Dilemma promote compliance of using ondansetron on an outpatient basis (21). Moreover, it may serve to reassure some parents who may be otherwise uncomfortable in taking their children home.…”

“…In Canada, the point-of-care administration of ondansetron is estimated to cost $12.86 while an ED visit costs $229.93, not including intravenous catheter insertion ($84), possible hospitalization ($955) or travel expenses for patients ($21.59) (18). A recent small study found that 24% of paediatric patients who were treated with a single dose of ondansetron for acute gastroenteritis in the ED reported experiencing recurrent emesis within 24 h of discharge (21). Perhaps the use of a physician-dispensed, asneeded home dose of ondansetron given to patients in anticipation of recurrent emesis and risk of dehydration may prevent a return to the ED.…”

“…A commonly cited reason against prescribing ondansetron for home use is fear of masking other diseases not identified at the initial visit (21). Due to this caution, many physicians use ondansetron in the ED but hesitate to prescribe it for home use (21).…”

“…A commonly cited reason against prescribing ondansetron for home use is fear of masking other diseases not identified at the initial visit (21). Due to this caution, many physicians use ondansetron in the ED but hesitate to prescribe it for home use (21). A recent small study involving paediatric patients with acute gastroenteritis found that a single dose of ondansetron given at home does not appear to increase the rate of alternative diagnoses (21).…”