Treat dehydration, protect the airway, and use ondansetron only within its age-specific pediatric order.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
SO-P-090 does not supply an ondansetron dose below age 4 or a routine pediatric IV regimen.
Use oral medication only when the child can safely tolerate it.
Assess severity
Assess hydration, perfusion, mental status, abdominal symptoms, duration, and ability to tolerate intake. Repeated vomiting can produce hypovolemia.
Maintain the airway and suction when needed. Consider an underlying illness rather than treating the symptom alone.
Fluid resuscitation
If dehydration or poor perfusion is present, establish IV/IO and give saline 20 mL/kg, maximum 250 mL per bolus, with base contact.
A pediatric-capable base is preferred. May repeat twice for three total boluses; reassess circulation and respiratory status between boluses.
Antiemetic & glucose
For ongoing nausea/vomiting in a child age 4 or older, give one 4 mg ondansetron ODT tablet to dissolve orally as tolerated. This is a fixed dose, not mg/kg.
If altered or unresponsive, check glucose. Below 60 mg/dL, follow the source options: oral glucose only with intact airway reflexes, D10 5 mL/kg IV (maximum 250 mL), or glucagon 0.5 mg IM if IV cannot be established. IO dextrose requires the listed additional criteria.
Reassessment & handoff
Reassess vomiting, airway protection, hydration, mental status, glucose response, and treatment tolerance. Marked hyperglycemia with vomiting may indicate DKA; follow the full source rather than assuming gastroenteritis.
Provide ALS transport to the nearest appropriate ERC and contact base as needed. Document age, weight, fluid totals, medication, and response.