Vomiting in children

Antiemetics are not recommended for treatment of uncomplicated vomiting in children limit use to prolonged vomiting of known etiology. 

Postoperative nausea and vomiting in children has been reviewed in detail, including multimodal strategies for management and prevention (55). 

ReidSR, BonadioWA. Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis. Ann Emerg Med 1996 28 318-323. 

Ginsburg CM, Clahsen J. Evaluation of trimethobenzamide hydrochloride (Tigan) suppositories for treatment of nausea and vomiting in children. J Pediatr 1980 96 767-769. 

Generally the azoles are well tolerated in children and adults mild side effects like nausea and vomiting are seen in <5% of the patients treated with FLU. 

The plasma half-life of 6-MP after intravenous bolus injection is 21 min in children and is twofold greater in adults. After oral intake peak levels are attained within 2 h. 6-MP is used for the treatment of ALL and has shown certain activity in chronic myelogenous leukemia. The major side effects involve myelosuppression, nausea, vomiting, and hepatic injury. 

Studies suggest that the use of salicylates (especially aspirin) maybe involved in the development of Reye s syndrome in children with chickenpox or influenza. This rare but life-threatening disorder is characterized by vomiting and lethargy, progressing to coma. Therefore, use of salicylates in children with chickenpox, fever, or flulikesymptomsisnot recommended. Acetaminophen is recommended for the management of symptoms associated with these disorders... 

Zanamivir was generally well tolerated in clinical trials (Fleming 2003). During treatment with oseltamivir, nausea and vomiting have been reported as side effects (Oxford 2005). A small number of severe adverse reactions in children, including neuropsychiatric events and skin hypersensitivity, have, however, been reported, primarily in Japan which has the highest use of oseltamivir (Li et al. 2007). 

Erythromycin- sulfisoxazole 50 mg/kg per day of erythromycin component in 3 4 doses Nausea, vomiting, abdominal pain, diarrhea, rash SS Many drug interactions (like clarithromycin), contraindicated in children under 2 months increasing pneumococcal resistance... 

Headache, abdominal pain, nausea, or vomiting (especially in children)... 

Teniposide, a topoisomerase II inhibitor, is administered as an infusion over 30 to 60 minutes to prevent hypotension. The pharmacokinetics are described by a three-compartment model, with an a half-life of 0.75 hours, a (5 half-life of 4 hours, and a terminal half-life of 20 hours. Considerable variability in clearance of teniposide in children has been reported.17 Teniposide has shown activity in the treatment of acute lymphocytic leukemia, neuroblastoma, and non-Hodgkin s lymphoma. Side effects include myelosuppression, nausea, vomiting, mucositis, and venous irritation. Hypersensitivity reactions may be life-threatening. 

Colic is also a symptom of lead poisoning in children. EPA (1986a) has identified a LOAEL of approximately 60-100 pg/dL for children. This value apparently is based on a National Academy of Sciences (NAS 1972) compilation of unpublished data from the patient groups originally discussed in Chisolm (1962, 1965) and Chisolm and Harrison (1956) in which other signs of acute lead poisoning, such as severe constipation, anorexia, and intermittent vomiting, occurred at 60 pg/dL. 

If vomiting is present and is uncontrollable with antiemetics, nothing is taken by mouth. As bowel movements decrease, a bland diet is begun. Feeding should continue in children with acute bacterial diarrhea. 

Nausea, vomiting, and otitis media are also commonly reported in children. 

Adverse reactions may include Stevens-Johnson syndrome pericardial effusion T-wave changes rebound hypertension (following gradual withdrawal in children) decreased initial hematocrit, hemoglobin and erythrocyte counts nausea vomiting temporary edema alkaline phosphatase/serum creatinine/BUN increase, hypertrichosis. 

Promethazine is not recommended in children younger than 2 years of age. Exercise caution when administering promethazine to children because of the potential for fatal respiratory depression. Limit antiemetics to prolonged vomiting of known etiology. Avoid use in children whose signs and symptoms may suggest Reye syndrome or other hepatic diseases. In children with dehydration, there is an increased susceptibility to dystonias with the use of promethazine. 

Nausea and vomiting Do not use in children younger than 6 months of age except where potentially lifesaving. Do not use in conditions for which specific children s dosages have not been established. The activity following IM use may last 12 hours. 

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