pediatrics
Nausea and Vomiting in Infants and Children
Treatment
Treatment of nausea and vomiting is targeted at the causative disorder. Treatment is important. Drugs frequently used in adults to decrease nausea and vomiting are used less often in children because the usefulness of treatment has not been proved and because these drugs have potential risks of adverse effects and of masking an underlying condition. However, if nausea or vomiting is severe or unremitting, antiemetic drugs can be used cautiously in children > 2 years. Useful drugs include Promethazine: For children > 2 years, 0.25 to 1 mg/kg (maximum 25 mg) orally, IM, IV, or rectally every 4 to 6 hours Prochlorperazine: For children > 2 years and weighing 9 to 13 kg, 2.5 mg orally every 12 to 24 hours; for those 13 to 18 kg, 2.5 mg orally every 8 to 12 hours; for those 18 to 39 kg, 2.5 mg orally every 8 hours; for those > 39 kg, 5 to 10 mg orally every 6 to 8 hours Metoclopramide: 0.1 mg/kg orally or IV every 6 hours (maximum 10 mg/dose) Ondansetron: 0.15 mg/kg (maximum 8 mg) IV every 8 hours or, if the oral form is used, for children 2 to 4 years, 2 mg every 8 hours; for those 4 to 11 years, 4 mg every 8 hours; for those ≥ 12 years, 8 mg every 8 hours Promethazineis an H1 receptor blocker (antihistamine) that inhibits the emetic center response to peripheral stimulants. The most common adverse effects are respiratory depression, sedation, dizziness, anxiety, blurred vision, dry mouth, impotence, and constipation; the drug is contraindicated in children < 2 years. Therapeutic doses ofpromethazinecan cause extrapyramidal adverse effects, including torticollis. Prochlorperazineis a weakdopaminereceptor blocker that depresses the chemoreceptor trigger zone. Drowsiness, dizziness, anxiety, strange dreams, insomnia, galactorrhea, akathisia, and dystonia are the most common adverse effects. Metoclopramideis adopaminereceptor antagonist that acts both centrally and peripherally by increasing gastric motility and decreasing afferent impulses to the chemoreceptor trigger zone. Drowsiness, dizziness, agitation, headache, diarrhea, akathisia, and dystonia are the most common adverse effects. is safe and effective in children who have acute gastroenteritis and are unable to tolerate Oral Rehydration (ORT). By facilitating ORT, this drug may prevent the need for IV fluids or, in children given IV fluids, may help prevent hospitalization. Typically, only a single dose is used because repeated doses can cause persistent diarrhea. Other common adverse effects include headache, dizziness, drowsiness, blurred vision, constipation, muscle stiffness, tachycardia, and hallucinations. 