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Emergency department ondansetron use in children with type 1 diabetes mellitus and vomiting

James S Leung1, Kusiel Perlman2, Maggie Rumantir3

  • 1Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.

The Journal of Pediatrics
|December 3, 2014
PubMed

Insights

Ondansetron did not reduce hospital admissions for children with type 1 diabetes and vomiting. However, over time, reduced admissions, shorter stays, and less IV fluid use were observed in these pediatric patients.

Area of Science:

  • Pediatric Emergency Medicine
  • Endocrinology
  • Clinical Pharmacology

Background:

  • Children with type 1 diabetes mellitus (T1DM) presenting to the emergency department (ED) with vomiting often require hospitalization.
  • Ondansetron is a 5-HT3 receptor antagonist used to treat nausea and vomiting.
  • Assessing ondansetron's impact on clinical outcomes in this pediatric population is crucial for optimizing care.

Purpose of the Study:

  • To evaluate if ondansetron administration reduces hospitalization rates in children with T1DM and vomiting.
  • To determine if ondansetron impacts ED length of stay, intravenous fluid (IVF) administration, and revisit rates.

Main Methods:

  • A 10-year retrospective cohort study of 345 ED encounters involving children aged 6 months to 8 years with T1DM and vomiting.
  • Comparison of outcomes between children who received ondansetron and those who did not.
  • Analysis of outcomes based on ondansetron usage periods (low vs. high usage) to mitigate selection bias.

Main Results:

  • Ondansetron use increased significantly from 0% to 67% between 2002 and 2011.
  • No significant difference in admission rates was found between ondansetron and non-ondansetron groups (54% vs. 55%).
  • Length of stay was longer in the ondansetron group (409 vs. 315 minutes; P=.03), while IVF administration and revisits were similar. Comparing low vs. high ondansetron usage periods showed reduced admissions, shorter stays, and decreased IVF administration in the high usage period.

Conclusions:

  • Ondansetron administration was not independently associated with reduced hospital admissions in children with T1DM and vomiting.
  • Despite the lack of independent association, concurrent trends show decreased admissions, shorter ED stays, and reduced IVF administration over time, coinciding with increased ondansetron use.
Abstract

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