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I limit my discharge use of Zofran for vomiting children who improve in 
my ED to those who are most like the "little adults" we all know and 
love. My rationale (no evidence) for not  prescribing take-home Zofran  
for preverbal children is as follows:
     Vomiting often brings kids and parents in early. Vomiting in young 
children can be the first nonspecific sign of illnesses  ranging in 
severity from otitis media, to appendicitis, to meningitis. Zofran works 
for vomiting from all these causes. I worry about providing enough 
Zofran to keep a young child at home for another day or more when they 
have persistent vomiting from a more serious cause. Plus, now they can 
keep the antipyretics down, fever becomes a less prominent concern. I 
would rather see them back soon if they are still vomiting, and I make 
all this part of my discharge instructions. The usual, otherwise well, 
single-dose-in-the-ER kids with benign illnesses rarely seem to return. 
Likewise, a stash of unused Zofran at home that can be started with the 
next vomiting illness may delay that doctor visit.  When the well child 
in front of me seems to have AGE and is old enough to tell mom if their 
head, tummy, or ear hurts, my threshold for prescribing is lower.
     On the subject of "s.l. Zofran, PO challenge, and out-the-door" for 
otherwise well children with vomiting: I try to remember to make the 
distinction to the parents between treating nausea, which we have done, 
with treating dehydration/volume depletion, which we are thankfully NOT 
doing in the ED for the vast majority of these kids. We used to fix both 
with IV fluids way more frequently before ondansetron.  I try to make it 
clear that we have only fixed half the problem, and, in return for 
rapidly fixing the nausea, treating the dehydration has become their 
job. I let them know that standard oral rehydration requires a minimum 
of 100ml/kg (a liter for that 10 kilo kid) over 24 hours, plus 
replacement of ongoing losses at 1:1. The moderately dehydrated child, 
doing better at discharge, is recommended to have 100ml/kg in 4 hours.

"Of course that's just my opinion, I could be wrong." - Dennis Miller

My best to the list,

Ken Frumkin
Naval Medical Center, Portsmouth, Virginia

Required Disclaimer: The views expressed are my own, and do not 
necessarily reflect the official policy or position of the,Department of 
the Navy, Department of Defense, or the United States Government.



> Gill Winnik <mailto:[log in to unmask]>
> December 19, 2015 at 10:00 PM
> While I routinely use Zofran for my nausea/vomiting patients, I do not 
> discharge pediatric patients with a prescription for Zofran. I'm not 
> sure what the rationale for that is perhaps the idea is that if there 
> is a serious cause for the nausea/vomiting the patient should come 
> back and it should not be masked by Zofran but the same can be said 
> for Tylenol or Motrin.
> So my question to the group is does anyone routinely prescribe Zofran 
> to discharged children who presented with nausea forward/vomiting?
> Did anyone have a bad experience doing this?
> Thank you
>
> Gill (Giora) Winnik
>
>
>
>
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> Michael Falk <mailto:[log in to unmask]>
> December 17, 2015 at 3:03 PM
> None perf and pre-operatively, ancef/mefoxitin. If perforated or chance,
> Zosyn.
> Mike Falk.
>
> On Thu, Dec 17, 2015 at 1:42 PM, Todd Zimmerman <
>
> For more information, send mail to [log in to unmask] with 
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> Todd Zimmerman <mailto:[log in to unmask]>
> December 17, 2015 at 1:42 PM
> For appe, what abx are you using.
> For those using Rocephin and Flagyl, what dose of Flagyl are you using 
> in the er, 10 per kg or 30 per kg?
> And Rocpehin?
>
> This is a bit more generalized, as there are obviously many different 
> practice styles that remain within safety...For your DKA, what volume 
> of fluids and over how long are you giving the first amount.I give 
> between 10 and 20 ml per kg over 60 minutes.
> And finally, who thinks Michigan State will win CFB? Hoops?
> Thanks,Todd Z(Please don't quote up to date, I read it)
>
>
> Sent from my Verizon Wireless 4G LTE smartphone
>
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