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Published in: BMC Pediatrics 1/2021

Open Access 01-12-2021 | Acute Gastroenteritis | Research

The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study

Authors: Heewon Yang, Woochan Jeon, Yura Ko, Sooin Jeong, Jisook Lee

Published in: BMC Pediatrics | Issue 1/2021

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Abstract

Background

In mildly to moderately dehydrated patients with acute gastroenteritis (AGE), oral rehydration therapy (ORT) is the treatment of choice. Though ondansetron is a very effective antiemetics and leads to succeed ORT, there have been reports QT prolongation in patients using it. We investigated the effect of oral ondansetron on QT interval in mildly to moderately dehydrated children with AGE.

Methods

This retrospective observational study was conducted in a single pediatric emergency department (ED) of a tertiary university hospital. We collected the medical records of patients with a primary diagnosis of AGE who received oral ondansetron and underwent an electrocardiogram between January 2017 and June 2018. A pediatric emergency physician calculated the corrected QT interval (QTc) by Bazett’s method, and the calculations were reviewed by a pediatric cardiologist. QTc values before (preQTc) and after (postQTc) ondansetron administration were analyzed. ΔQTc was calculated as the change from preQTc to postQTc. We also investigated any cardiac complications from oral ondansetron.

Results

Total 80 patients were included. The mean age of the patients was 53.31 ± 32.42 months, and 45% were male. The mean dose of oral ondansetron was 0.18 ± 0.04 mg/kg. The mean interval from administration of ondansetron to performance of the electrocardiogram was 65 ± 26 min. The mean preQTc was 403.3 ± 24.0 ms, and the mean postQTc was 407.2 ± 26.7 ms. Two patients had a preQTc ≥460 ms, and one patient had a postQTc ≥460 ms. ΔQTc was ≥30 ms in seven patients (8.8%). No ΔQTc was ≥60 ms. No pre- or postQTc was ≥500 ms. No patient had a fatal cardiac arrhythmia after taking ondansetron.

Conclusion

Oral administration of a single dose of ondansetron in children with AGE did not cause high-risk QTc prolongation or fatal arrhythmia.
Literature
1.
go back to reference GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544.CrossRef GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544.CrossRef
2.
go back to reference Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. 2006;354:1698–705.CrossRef Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. 2006;354:1698–705.CrossRef
3.
go back to reference Freedman SB, Steiner MJ, Chan KJ. Oral ondansetron administration in emergency departments to children with gastroenteritis: an economic analysis. PLoS Med. 2010;7(10):e1000350. Freedman SB, Steiner MJ, Chan KJ. Oral ondansetron administration in emergency departments to children with gastroenteritis: an economic analysis. PLoS Med. 2010;7(10):e1000350.
4.
go back to reference Rutman L, Klein EJ, Brown JC. Clinical pathway produces sustained improvement in acute gastroenteritis care. Pediatrics. 2017;140(4):e20164310.CrossRef Rutman L, Klein EJ, Brown JC. Clinical pathway produces sustained improvement in acute gastroenteritis care. Pediatrics. 2017;140(4):e20164310.CrossRef
5.
go back to reference Danewa AS, Shah D, Batra P, Bhattacharya SK, Gupta P. Oral Ondansetron in Management of Dehydrating Diarrhea with vomiting in children aged 3 months to 5 years: a randomized controlled trial. J Pediatr. 2016;169:105–9 e3.CrossRef Danewa AS, Shah D, Batra P, Bhattacharya SK, Gupta P. Oral Ondansetron in Management of Dehydrating Diarrhea with vomiting in children aged 3 months to 5 years: a randomized controlled trial. J Pediatr. 2016;169:105–9 e3.CrossRef
6.
go back to reference Freedman SB, Powell EC, Nava-Ocampo AA, Finkelstein Y. Ondansetron dosing in pediatric gastroenteritis: a prospective cohort, dose-response study. Paediatr Drugs. 2010;12:405–10.CrossRef Freedman SB, Powell EC, Nava-Ocampo AA, Finkelstein Y. Ondansetron dosing in pediatric gastroenteritis: a prospective cohort, dose-response study. Paediatr Drugs. 2010;12:405–10.CrossRef
7.
go back to reference Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, et al. Oral Ondansetron versus Domperidone for acute gastroenteritis in pediatric emergency departments: multicenter double blind randomized controlled trial. PLoS One. 2016;11:e0165441.CrossRef Marchetti F, Bonati M, Maestro A, Zanon D, Rovere F, Arrighini A, et al. Oral Ondansetron versus Domperidone for acute gastroenteritis in pediatric emergency departments: multicenter double blind randomized controlled trial. PLoS One. 2016;11:e0165441.CrossRef
8.
go back to reference Ramsook C, Sahagun-Carreon I, Kozinetz CA, Moro-Sutherland D. A randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritis. Ann Emerg Med. 2002;39:397–403.CrossRef Ramsook C, Sahagun-Carreon I, Kozinetz CA, Moro-Sutherland D. A randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritis. Ann Emerg Med. 2002;39:397–403.CrossRef
9.
go back to reference Krammes SK, Jacobs T, Clark JM, Lutes RE. Effect of intravenous Ondansetron on the QT interval of Patients' electrocardiograms. Pediatr Emerg Care. 2018;34:38–41.CrossRef Krammes SK, Jacobs T, Clark JM, Lutes RE. Effect of intravenous Ondansetron on the QT interval of Patients' electrocardiograms. Pediatr Emerg Care. 2018;34:38–41.CrossRef
10.
go back to reference Hoffman RJ, Alansari K. Effect of intravenous ondansetron on QTc interval in children with gastroenteritis. Am J Emerg Med. 2018;36:754–7.CrossRef Hoffman RJ, Alansari K. Effect of intravenous ondansetron on QTc interval in children with gastroenteritis. Am J Emerg Med. 2018;36:754–7.CrossRef
11.
go back to reference Freedman SB, Uleryk E, Rumantir M, Finkelstein Y. Ondansetron and the risk of cardiac arrhythmias: a systematic review and postmarketing analysis. Ann Emerg Med. 2014;64:19–25.e6.CrossRef Freedman SB, Uleryk E, Rumantir M, Finkelstein Y. Ondansetron and the risk of cardiac arrhythmias: a systematic review and postmarketing analysis. Ann Emerg Med. 2014;64:19–25.e6.CrossRef
12.
go back to reference Zuo P, Haberer LJ, Fang L, Hunt TL, Ridgway D, Russo MW. Integration of modeling and simulation to support changes to ondansetron dosing following a randomized, double-blind, placebo-, and active-controlled thorough QT study. J Clin Pharmacol. 2014;54:1221–9.CrossRef Zuo P, Haberer LJ, Fang L, Hunt TL, Ridgway D, Russo MW. Integration of modeling and simulation to support changes to ondansetron dosing following a randomized, double-blind, placebo-, and active-controlled thorough QT study. J Clin Pharmacol. 2014;54:1221–9.CrossRef
13.
go back to reference Hervas D, Armero C, Carrion T, Utrera JF, Hervas JA. Clinical and economic impact of oral ondansetron for vomiting in a pediatric emergency department. Pediatr Emerg Care. 2012;28:1166–8.CrossRef Hervas D, Armero C, Carrion T, Utrera JF, Hervas JA. Clinical and economic impact of oral ondansetron for vomiting in a pediatric emergency department. Pediatr Emerg Care. 2012;28:1166–8.CrossRef
14.
go back to reference Friedman JN, Goldman RD, Srivastava R, Parkin PC. Development of a clinical dehydration scale for use in children between 1 and 36 months of age. J Pediatr. 2004;145(2):201–7.CrossRef Friedman JN, Goldman RD, Srivastava R, Parkin PC. Development of a clinical dehydration scale for use in children between 1 and 36 months of age. J Pediatr. 2004;145(2):201–7.CrossRef
15.
16.
go back to reference Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is "normal". J Cardiovasc Electrophysiol. 2006;17:333–6.CrossRef Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is "normal". J Cardiovasc Electrophysiol. 2006;17:333–6.CrossRef
17.
go back to reference Lepeschkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation. 1952;6:378–88.CrossRef Lepeschkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation. 1952;6:378–88.CrossRef
18.
go back to reference Trivedi S, Schiltz B, Kanipakam R, Bos JM, Ackerman MJ, Ouellette Y. Effect of Ondansetron on QT interval in patients cared for in the PICU. Pediatr Crit Care Med. 2016;17:e317–23.CrossRef Trivedi S, Schiltz B, Kanipakam R, Bos JM, Ackerman MJ, Ouellette Y. Effect of Ondansetron on QT interval in patients cared for in the PICU. Pediatr Crit Care Med. 2016;17:e317–23.CrossRef
19.
go back to reference Patanwala AE, Amini R, Hays DP, Rosen P. Antiemetic therapy for nausea and vomiting in the emergency department. J Emerg Med. 2010;39:330–6.CrossRef Patanwala AE, Amini R, Hays DP, Rosen P. Antiemetic therapy for nausea and vomiting in the emergency department. J Emerg Med. 2010;39:330–6.CrossRef
20.
go back to reference Moffett PM, Cartwright L, Grossart EA, O'Keefe D, Kang CS. Intravenous Ondansetron and the QT interval in adult emergency department patients: an observational study. Acad Emerg Med. 2016;23:102–5.CrossRef Moffett PM, Cartwright L, Grossart EA, O'Keefe D, Kang CS. Intravenous Ondansetron and the QT interval in adult emergency department patients: an observational study. Acad Emerg Med. 2016;23:102–5.CrossRef
21.
go back to reference Roila F, Del Favero A. Ondansetron clinical pharmacokinetics. Clin Pharmacokinet. 1995;29:95–109.CrossRef Roila F, Del Favero A. Ondansetron clinical pharmacokinetics. Clin Pharmacokinet. 1995;29:95–109.CrossRef
22.
go back to reference Mehta D, Sanatani S, Whyte SD. The effects of droperidol and ondansetron on dispersion of myocardial repolarization in children. Paediatr Anaesth. 2010;20:905–12.CrossRef Mehta D, Sanatani S, Whyte SD. The effects of droperidol and ondansetron on dispersion of myocardial repolarization in children. Paediatr Anaesth. 2010;20:905–12.CrossRef
23.
go back to reference Freedman SB, Soofi SB, Willan AR, Williamson-Urquhart S, Siddiqui E, Xie J, et al. Oral Ondansetron Administration to Dehydrated Children in Pakistan: A Randomized Clinical Trial. Pediatrics. 2019;144(6):e20192161. Freedman SB, Soofi SB, Willan AR, Williamson-Urquhart S, Siddiqui E, Xie J, et al. Oral Ondansetron Administration to Dehydrated Children in Pakistan: A Randomized Clinical Trial. Pediatrics. 2019;144(6):e20192161.
Metadata
Title
The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study
Authors
Heewon Yang
Woochan Jeon
Yura Ko
Sooin Jeong
Jisook Lee
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-021-02937-0

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