# Nausea, vomiting & dehydration

Manage airway risk, assess perfusion, and use the adult or pediatric antiemetic pathway.

Population: Adult & pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/nausea-vomiting/
Official source: [SO-M-060 — Nausea / Vomiting](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12040.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Adult ondansetron orders exclude known or suspected pregnancy.
- Use the pediatric age restriction and fluid maximums explicitly; do not scale the adult ODT regimen by weight.

## Source documents

- [SO-M-060 — Nausea / Vomiting](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12040.pdf)
- [SO-P-090 — Nausea / Vomiting - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf)

## Assess before treating symptoms

- Evaluate airway protection, vomiting, perfusion, and signs of dehydration. Keep suction available and maintain the airway.
- An altered level of consciousness or severe poor perfusion should prompt the applicable broader condition order rather than an antiemetic-only approach.

## Adult / adolescent

- For dehydration or poor perfusion with clear lungs/no CHF, give 250 mL saline boluses up to 1 L as needed for perfusion.
- For continued nausea/vomiting when pregnancy is not known or suspected: ondansetron 8 mg ODT, or 4 mg IV. The IV dose may repeat once after about 3 minutes for continued/recurrent symptoms.
- Transport to an appropriate ERC, with ALS escort when medication or fluids were needed.

## Pediatric — SO-P-090

- For dehydration/poor perfusion, give 20 mL/kg saline IV/IO, maximum 250 mL per bolus, and contact base (pediatric-capable preferred). May repeat twice for 3 total boluses.
- Age 4 and older: one 4 mg ondansetron ODT as tolerated. The source does not give an ODT regimen below age 4 or routine pediatric IV ondansetron.
- If altered/unresponsive, check glucose and follow the source’s hypoglycemia treatment, including the limited IO dextrose exception.

## Reassess & handoff

- Reassess airway protection, vomiting frequency, mental status, vital signs, and response to fluid or medication. Document dose times and total fluid.
- Pediatric vomiting can accompany diabetic ketoacidosis with marked hyperglycemia; assess the underlying cause and perfusion, not just symptom relief.