Management of Acute Vomiting in Pediatric Patients

Assessment and Treatment

For a patient with acute vomiting, the American College of Emergency Physicians recommends oral rehydration solution (ORS) as the first-line treatment for mild-to-moderate dehydration, with 120-240 mL ORS administered for each vomiting episode, up to approximately 1 L per day 1, 2
Intravenous normal saline should be reserved for severe dehydration, shock, or ORS failure, with 20 mL/kg boluses administered until hemodynamic stability is achieved, which is approximately 620 mL per bolus for a 31kg patient 1, 2
The American College of Emergency Physicians suggests initial rates of 5-10 mL/kg in the first 5 minutes for resuscitation 3

Administer 20 mL/kg boluses of isotonic crystalloid (normal saline or lactated Ringer's) for severe dehydration, shock, or ORS failure 1, 2
Repeat boluses until pulse, perfusion, and mental status normalize 1, 2

Establish continuous vital sign monitoring during rapid IV fluid administration 3
Adjust electrolytes and administer dextrose based on chemistry values when using IV therapy 1, 2
Patients with congestive heart failure or chronic renal disease require close monitoring to prevent volume overload 3