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Indian Pediatr 2019;56:887-888 |
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Intravenous Ondansetron
to Reduce Intravenous Rehydration – Will it be Successful?
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S Chandrasekar and Joseph John*
Department of Pediatrics, All India Institute of
Medical Sciences, Bhubaneswar, Odisha, India.
Email: *[email protected]
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We read with interest the research article by Rang,
et al. [1] published recently in Indian Pediatrics. Though
the article is very informative, we have some concerns:
It is clearly established that ondansetron is an
effective antiemetic [2]; hence, comparing the efficacy of intravenous
(IV) ondansetron with a placebo in reducing vomiting episodes and the
need for IV rehydration is unfair. The results reflected are expected (e.g.,
comparing vomiting episodes at 4, 8 and 24 hours between the ondansetron
group and placebo groups). To put this into perspective, it is like
comparing reduction in fever in two groups; to one group after giving
paracetamol and the other after administering a placebo, and saying that
there was a significant decrease in fever in the subjects in the
paracetamol group. Instead, it would have been more informative and
useful, if the authors had compared two different routes of
administration of ondansetron.
The process of double blinding is not clear as a
statement in the article mentions that "the study physician opened the
envelope to determine which treatment the subject would receive." It is
desirable to describe the process of blinding by explaining who was
blinded rather than use terms like double blind or triple blind.
The Oral rehydration solution (ORS) administration
must also have been a challenge for the caregivers/hospital staff who
were providing ORS at 0.5 mL/kg every 2 minutes. The question that comes
to our mind is as to how it was adhered to, especially in these young
children? Rehydration has been mentioned as ‘adequate’ when the child
consumed ³40
mL/kg of ORS solution, but the time over which it was consumed has not
been elucidated. Furthermore, there has been no mention on the day from
the start of symptoms that the patients were recruited into the study.
This information is important, as those included later may have
responded differently from those presenting earlier. Similarly, the
work-up for etiology of diarrhea was either not done or was not
provided, and the definition of ‘persistent vomiting’ that prompted the
physician to advise IV rehydration has also not been mentioned.
Acknowledgement: Dr Rashmi Ranjan Das for
academic inputs.
References
1. Rang NN, Chanh TQ, My PT, Tien TTM. Single-dose
intravenous ondansetron in children with gastroenteritis: A randomized
controlled trial. Indian Pediatr. 2019;56:468-71.
2. Reeves JJ, Shannon MW, Fleisher GR. Ondansetron
decreases vomiting associated with acute gastroenteritis: A randomized,
controlled trial. Pediatrics. 2002;109:e62.
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