Background: Acute gastroenteritis (AGE) is a very common emergency department (ED) presentation, with “approximately 1.5 million pediatric outpatient visits and 200,000 admissions” each year (Benary). Treatment for AGE is mainly supportive, utilizing rehydration therapy and antiemetic medications. One common and well studied antiemetic is ondansetron, which has been shown to be effective at controlling vomiting and decreasing hospitalization rates in pediatric patients. Despite its widespread use within the emergency department, there is significant variation in the use of ondansetron as a discharge prescription, with providers noting the fear of masking a worsening condition or missed diagnosis and thus preventing a necessary return visit.
Association of Maternal First-Trimester Ondansetron Use with Cardiac Malformations and Oral Clefts in Newborns
Background Information: Nausea and vomiting during pregnancy most commonly occurs during the first trimester. If left untreated, the development of hyperemesis gravidarum can lead to further complications characterized by dehydration and electrolyte abnormalities.1 Ondansetron, a 5-HT3 receptor antagonist has quickly become the most frequently prescribed drug in the United States for nausea and vomiting during pregnancy.2 With the creation of an oral dissolving tablet in 2006, Ondansetron’s popularity as an antiemetic continues to rise. In fact, a study from 2014 shows that nearly a quarter of all pregnant women in the United States are using it.3 There is uncertainty in the literature as to the association between Ondansetron and birth defects. While some studies report there is no increased risk in congenital abnormalities among women who took this antiemetic early in pregnancy, other evidence suggests it may be associated with cleft palate and cardiac malformations.2 The authors of this study sought to investigate the association between exposure to Ondansetron during the first trimester of pregnancy and risk of congenital malformations in newborns using a national cohort of publicly insured pregnant women.
In this Episode 127 Drugs that Work and Drugs that Don't Part 2 - Antiemetics, Angioedema and Oxygen, with Justin Morgenstern and Joel Lexchin we discuss the evidence for various antiemetics like metoclopramide, prochlorperazine, promethazine, droperidol, ondansetron, inhaled isopropyl alcohol and haloperidol as well as why should not use an antiemetic routinely with morphine in the ED. We then discuss the evidence for various drugs options for a potpourri of true emergencies like angioedema and hyperkalemia, and wrap it up with a discussion on oxygen therapy...
The post Ep 127 EM Drugs that Work and Drugs that Don’t Part 2 – Antiemetics, Angioedema, Oxygen appeared first on Emergency Medicine Cases.