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Diagnostic delay after dimenhydrinate use in vomiting children
K W Anquist1, S Panchanathan, P C Rowe
1Department of Pediatrics, University of Ottawa, Ont.
Insights
Dimenhydrinate use in children with vomiting may delay diagnosis of serious conditions. This study found children given dimenhydrinate were more likely to present later with treatable illnesses.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacovigilance
- Clinical Toxicology
Background:
- Vomiting is a common pediatric emergency department complaint.
- Dimenhydrinate is frequently used for nausea and vomiting.
- Potential risks of dimenhydrinate include masking serious underlying conditions.
Observation:
- A study surveyed parents of 148 children presenting with vomiting.
- 21% of children received dimenhydrinate prior to emergency department arrival.
- Poison control center data reviewed adverse drug reactions and inquiries.
Findings:
- Children who received dimenhydrinate were significantly more likely to present over 12 hours after vomiting onset (67% vs 34%).
- Diagnoses in dimenhydrinate recipients included asthma, pelvic inflammatory disease, and urinary tract infections.
- No significant direct adverse reactions to dimenhydrinate were documented.
Implications:
- Dimenhydrinate administration may delay the diagnosis and management of treatable pediatric illnesses.
- Clinicians should consider the potential for delayed presentation when dimenhydrinate is used.
- Further research is needed to understand the full impact of dimenhydrinate on pediatric diagnostic timelines.
Objective:
To determine whether the use of dimenhydrinate was associated with delay in the diagnosis and management of treatable illnesses or with direct adverse effects in children with vomiting presenting to an emergency department.
Design:
Questionnaire survey and review of drug reaction and telephone inquiry records.
Setting:
The emergency department of a tertiary care children's hospital and a provincial poison information centre.
Patients:
The parents of 148 children who presented with vomiting completed the questionnaire. The database at the poison information centre included 474 reports of adverse drug reactions over an 8-year period and 105 reports of telephone inquiries over a 4-year period.
Main Results:
Twenty-one (14%) of 148 children had received dimenhydrinate before arrival at the emergency department. The patients who had received dimenhydrinate were more likely than the others to present more than 12 hours after the onset of vomiting (14 [67%] of 21 v. 43 [34%] of 127, p less than 0.01). The discharge diagnoses for those who had received dimenhydrinate included asthma, pelvic inflammatory disease and urinary tract infection. No clinically important direct adverse reactions to dimenhydrinate were documented.
Conclusions:
The use of dimenhydrinate in children with vomiting is associated with a risk of delay in the diagnosis of treatable medical conditions.