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Clinical Practice: Nausea and vomiting in acute gastroenteritis: physiopathology and management

Abstract

Currently recommended management of acute gastroenteritis is supportive. Although the affected children habitually have vomiting, recommendations do not focus on the correction of this symptom. In this condition, elevated ketone bodies and stimuli initiated by gut mucosa damage produced by the enteral pathogen likely underlay nausea and vomiting. As compared to 0.9% saline, intravenous administration of a dextrose-containing bolus of 0.9% saline is associated with a greater reduction of circulating ketones and a shorter duration of nausea and vomiting. Nonetheless, this treatment strategy is not followed by a lower rate of hospitalization.

Conclusion: Well-designed investigations suggest that antagonists of the type 3 serotonin receptor, most frequently oral ondansetron, reduce the rate of vomiting, improve the tolerance of oral rehydration, and reduce the need for intravenous rehydration.

What is Known:
Although children with gastroenteritis habitually have vomiting, current recommendations do not focus on the correction of this symptom.
What is New:
Recently acquired evidence supports the prescription of ondansetron, an antagonist of the type 3 serotonin receptor, to increase the success rate of oral rehydration therapy.

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Acknowledgments

S.A.G.L. is the current recipient of a research grant from the Fondazione Ettore e Valeria Rossi. G. P. M. is the current recipient of research grants from the Fondazione G. & D. de Marchi ONLUS. The authors would like to thank Dr. Alec Villa for his assistance in the linguistic revision.

Author information

Concept of the manuscript: B.C., S.A.G.L., M.G.B., and G.P.M; Acquisition of data: B.C. and P.U.; Figures: B.C., M.G.B., and S.A.G.L.; Drafting of the manuscript: B.C., M.G.B., and G.P.M.; Critical revision of the manuscript: E.F.F. and C.A.; Final manuscript: B.C., M.G.B., S.A.G.L., and G.P.M.

Correspondence to Gregorio P. Milani.

Ethics declarations

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

Not applicable (review study).

Informed consent

Not applicable (review study).

Additional information

Communicated by Peter de Winter

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Canziani, B.C., Uestuener, P., Fossali, E.F. et al. Clinical Practice: Nausea and vomiting in acute gastroenteritis: physiopathology and management. Eur J Pediatr 177, 1–5 (2018). https://doi.org/10.1007/s00431-017-3006-9

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Keywords

  • Acute gastroenteritis
  • Antagonists of the type 3 serotonin receptor
  • Ketosis
  • Ondansetron
  • Vomiting