# Acute vomiting in children (non-surgical) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Pediatric Dehydration - StatPearls (NCBI Bookshelf NBK436022) - https://www.ncbi.nlm.nih.gov/books/NBK436022/ · Viral Gastroenteritis - StatPearls (NCBI Bookshelf NBK518995) - https://www.ncbi.nlm.nih.gov/books/NBK518995/ · Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting-full.txt) · Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting-clinical.txt) · MSF Essential Drugs 2024 - Oral rehydration salts = ORS (oral) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) - Verified date: 2026-08 ## Verified against - Pediatric Dehydration - StatPearls (NCBI Bookshelf NBK436022) - https://www.ncbi.nlm.nih.gov/books/NBK436022/ - Viral Gastroenteritis - StatPearls (NCBI Bookshelf NBK518995) - https://www.ncbi.nlm.nih.gov/books/NBK518995/ - Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting-full.txt) - Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting-clinical.txt) - MSF Essential Drugs 2024 - Oral rehydration salts = ORS (oral) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) ## Treatment metadata - ORS — oral.solution - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text ACUTE VOMITING IN CHILDREN (NON-SURGICAL) Sources: Pediatric Dehydration - StatPearls (NCBI Bookshelf NBK436022) - https://www.ncbi.nlm.nih.gov/books/NBK436022/ · Viral Gastroenteritis - StatPearls (NCBI Bookshelf NBK518995) - https://www.ncbi.nlm.nih.gov/books/NBK518995/ · Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting-full.txt) · Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting- clinical.txt) · MSF Essential Drugs 2024 - Oral rehydration salts = ORS (oral) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) Review status: REVIEWED against 6 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Mild dehydration may show only reduced urine output, while moderate dehydration adds dry mouth, poor skin turgor, delayed capillary refill, a fast heart rate, and irritability [cold peripheries · dehydration · dry mouth · irritability · tachycardia] - Severe dehydration presents as a very sick-looking child with altered mental status, lethargy, fast deep breathing, low blood pressure, and mottled skin [dehydration · hypotension · lethargy] - Low blood pressure and shock are late warning signs of poor organ perfusion needing emergency fluids [hypotension · shock] SIGNS - what you find (1) - Belly tenderness in a dehydrated child may point to an underlying acute abdominal cause needing its own workup [abdominal tenderness · dehydration] TESTS (5) - Severe vomiting in infants can cause a metabolic alkalosis from stomach acid loss, classically from untreated pyloric stenosis - Vomiting with dehydration can also show low blood sugar alongside the electrolyte disturbances - A serum bicarbonate under 17 mEq/L points to at least moderate dehydration - Urine specific gravity above 1.015 reflects the kidneys concentrating urine in mild dehydration, while urine ketones suggest a more severe degree - Serum sodium classifies dehydration as isonatremic, hyponatremic, or hypernatremic and guides fluid choice IF NOT THIS - what else fits (6) - Pyloric stenosis can obstruct the gut, driving vomiting and fluid loss - Malrotation with volvulus is a structural cause of vomiting and fluid loss to rule out - Viral or bacterial gastroenteritis is a common infectious cause of vomiting and fluid loss - A urinary tract infection can present with vomiting and should be on the differential - Diabetic ketoacidosis is a metabolic cause with impaired water and electrolyte regulation to consider - Congenital adrenal hyperplasia is a metabolic cause to consider Source StatPearls "Pediatric Dehydration" - disease-level clinical article Status traced to the source above 1. ORS [1st line] Adult Not applicable - the volumes are weight-based and are given under paediatric dosing Peds 50-100 mL/kg/dose (The calculator above gives the replacement volume for mild-to- moderate dehydration, spread over 3 to 4 hours - 50 to 100 mL/kg at that severity. Give it in 5 mL doses every 1 to 2 minutes, which the article reports as usually tolerated. Then keep replacing what is still being lost: a child under 2 with mild dehydration gets a further 50 to 100 mL for every vomit or diarrhoeal episode, and 10 to 20 mL/kg of body weight should go back for each diarrhoeal stool. The MSF sachet figures for ongoing losses, by age, are 50 to 100 mL after each loose stool under 24 months, 100 to 200 mL from 2 to 10 years, and 200 to 400 mL over 10 years.) Under 2 years: 50 to 100 mL of ORS after each loose stool or vomit, on top of the replacement volume above 2 to 10 years: 100 to 200 mL of ORS after each loose stool, on top of the replacement volume above Over 10 years: 200 to 400 mL of ORS after each loose stool, on top of the replacement volume above 3kg -> 150-300 mL/dose 4kg -> 200-400 mL/dose 5kg -> 250-500 mL/dose 6kg -> 300-600 mL/dose 7kg -> 350-700 mL/dose 8kg -> 400-800 mL/dose 9kg -> 450-900 mL/dose 10kg -> 500-1000 mL/dose 11kg -> 550-1100 mL/dose 12kg -> 600-1200 mL/dose 13kg -> 650-1300 mL/dose 14kg -> 700-1400 mL/dose 15kg -> 750-1500 mL/dose 16kg -> 800-1600 mL/dose 17kg -> 850-1700 mL/dose 18kg -> 900-1800 mL/dose 19kg -> 950-1900 mL/dose 20kg -> 1000-2000 mL/dose 21kg -> 1050-2100 mL/dose 22kg -> 1100-2200 mL/dose 23kg -> 1150-2300 mL/dose 24kg -> 1200-2400 mL/dose 25kg -> 1250-2500 mL/dose 26kg -> 1300-2600 mL/dose 27kg -> 1350-2700 mL/dose 28kg -> 1400-2800 mL/dose 29kg -> 1450-2900 mL/dose 30kg -> 1500-3000 mL/dose 31kg -> 1550-3100 mL/dose 32kg -> 1600-3200 mL/dose 33kg -> 1650-3300 mL/dose 34kg -> 1700-3400 mL/dose 35kg -> 1750-3500 mL/dose 36kg -> 1800-3600 mL/dose 37kg -> 1850-3700 mL/dose 38kg -> 1900-3800 mL/dose 39kg -> 1950-3900 mL/dose 40kg -> 2000-4000 mL/dose 41kg -> 2050-4100 mL/dose 42kg -> 2100-4200 mL/dose 43kg -> 2150-4300 mL/dose 44kg -> 2200-4400 mL/dose 45kg -> 2250-4500 mL/dose 46kg -> 2300-4600 mL/dose 47kg -> 2350-4700 mL/dose 48kg -> 2400-4800 mL/dose 49kg -> 2450-4900 mL/dose 50kg -> 2500-5000 mL/dose Source Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting- full.txt) Why Indication and dose sit in the same opened article, and it is written for exactly this child. Indication: the World Health Organization and the American Academy of Pediatrics both put oral rehydration first where dehydration is mild or moderate, the aim being to return the child to normal fluid status. Dose: 50 to 100 mL/kg, given across 3 to 4 hours at that severity. The technique matters as much as the volume in a vomiting child - the fluid has to go in little and often, or it sets off the vomiting again. Caution GIVE IT BY THE SPOONFUL, NOT BY THE CUP - the article's own method is 5 mL at a time, repeated every 1 to 2 minutes; children usually keep that down, but it takes an adult sitting with the child throughout. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) A mother told to give fluids will offer a glass, the child will vomit it, and both will conclude that oral rehydration failed. IF THE CHILD VOMITS, PAUSE AND SLOW DOWN, DO NOT STOP - MSF's instruction is to hold the oral rehydration solution for 10 minutes, then start again more slowly, in very small and frequent amounts. Rehydration is not abandoned. MIX IT WITH THE FULL VOLUME OF WATER PRINTED ON THE PACK. Too little water is dangerous, not merely ineffective - a solution made up with less water than the pack states can push the sodium up, and that happens above all in infants with severe viral gastroenteritis who cannot keep pace with what they are losing. The MSF sachet dissolves in 1 litre of clean water; the ready-mixed 200 to 360 mL bottles sold in Egypt are already diluted and need no water added at all. AND USE IT THE SAME DAY - once it is made up, throw away what is left after 24 hours and mix a fresh lot. NOT JUICE, NOT COLA, NOT A SPORTS DRINK - sweet drinks (juice, fizzy drinks, sweetened tea, sports drinks) carry a sugar load the gut cannot absorb, which draws water into the bowel and can make the diarrhoea worse; a very salty broth pushes the sodium up instead. WHO and the AAP both say to use a properly prepared oral rehydration salt solution rather than a home-made mixture or an ordinary drink. KEEP THE BREAST ON THE BREAST - a breastfed infant carries on nursing throughout. For an older child with mild or moderate dehydration, the oral route is the first choice. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) WHEN ORAL REHYDRATION IS THE WRONG ROUTE - do not use it in a child whose consciousness is altered or who is at risk of inhaling the fluid, nor in ileus, malabsorption, vomiting that will not stop, or dehydration severe enough to need larger volumes than the mouth can deliver. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) Those children need a drip and a hospital. GRADE THE DEHYDRATION BEFORE CHOOSING THE VOLUME - mild dehydration may show nothing but a fall in urine output. Moderate adds a dry mouth, skin that stays pinched, slow capillary refill, a fast pulse and irritability. Severe looks ill: on top of the moderate signs, an altered conscious level and lethargy, deep rapid breathing, a low blood pressure and mottled skin. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) INFANTS DEHYDRATE FASTER - water makes up 70% to 80% of an infant's body weight against 60% to 65% in an older child, so at the same degree of dehydration the infant loses a bigger share of its weight. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) GO BACK TO NORMAL FOOD EARLY - once the vomiting is settling, offer small amounts of solid food and build back up to the child's usual diet for age. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) SPECIAL FORMULA IS FOR MALNOURISHED CHILDREN ONLY - ReSoMal, the modified oral rehydration formula, is reserved for severely malnourished children and is given under medical supervision. Cholera is the exception: a malnourished child with cholera gets the standard formula, not ReSoMal. Egypt GLUCOHYDRAN 10 SACHET. ARAB DRUG COM... 1.75 EGP REHYDRAN N 10 SACHET CID 4.50 EGP REHYDRO ZINC 10 SACHETS CID 7.00 EGP ORS 20 SACHETS PHAROPHARMA 40.00 EGP ELECTRO MASH SYRUP 200 ML MASH PREMIERE 60.00 EGP FLEXOLYTE ORAL REHYDRATION SOL. 240 ML KEMPETRO FOR CHEMICAL INDUSTRIES 65.00 EGP HERO ORS 200 ML HERO > HERO M... 120.00 EGP SANSO ORS SYRUP 140 ML AUG PHARMA 400.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute vomiting in children - disease-level clinical article (paediatric-acute-vomiting- clinical.txt) Why Vomiting in a child is a symptom before it is a diagnosis. Below are the surgical and metabolic causes that must be excluded, the point at which oral rehydration stops being the answer, and the reason no antiemetic is offered above. Caution NO ANTIEMETIC IS PRINTED HERE. The article does describe the practice - an antiemetic can make oral rehydration workable in a child who is vomiting hard, and so spare a drip, with ondansetron the drug usually chosen. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) But it names no strength, no frequency and no maximum for a child anywhere in it, so nothing is carried across. AND THE FORMULARY THAT DOES STATE A PAEDIATRIC ONDANSETRON DOSE STATES IT FOR A DIFFERENT ILLNESS. Its licensed uses are sickness caused by chemotherapy or radiotherapy - adults by mouth, by injection or by suppository, and children from 6 months by mouth or injection - and sickness after an operation, in adults by those same routes and in children from 1 month by injection only. Its paediatric dosing section is headed for chemotherapy-induced nausea and vomiting from 6 months to 17 years. Gastroenteritis is not among them, so no dose is carried across. METOCLOPRAMIDE IS NARROWER STILL IN CHILDREN. In the formulary its only oral paediatric use is preventing the delayed sickness that follows chemotherapy; it is a second-line choice in children even for that, and safety and efficacy below 1 year of age are not established. AND THE EVIDENCE FOR SENDING ONE HOME WITH THE CHILD IS THIN - the gastroenteritis article notes that although antiemetics are often prescribed for use at home in children, nothing clearly shows they cut the number who come back to the emergency department. (Viral Gastroenteritis - StatPearls - NCBI Bookshelf, NBK518995) RED FLAG - WHAT VOMITING WITH THESE FEATURES USUALLY IS NOT: a high fever, blood in the stool, vomiting that will not stop, or severe abdominal pain point away from a simple viral gastroenteritis and towards another cause. The article's own list of what to think of instead runs to appendicitis, bowel obstruction and diverticulitis. (Viral Gastroenteritis - StatPearls - NCBI Bookshelf, NBK518995) RED FLAG - THE SURGICAL CAUSES IN SMALL CHILDREN: a blockage of the gut - pyloric stenosis, or malrotation with volvulus - loses fluid and dehydrates the child. A projectile-vomiting infant who is hungry after each vomit, or a green vomit at any age, is a same-day surgical referral. EXAMINE THE ABDOMEN, DO NOT ONLY COUNT THE VOMITS - tenderness on palpation raises the possibility of an acute abdominal cause behind the dehydration, and that needs assessing and treating in its own right. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) RED FLAG - IT MAY NOT BE THE GUT AT ALL: dehydration usually follows vomiting, diarrhoea or simply not drinking, but it can equally be the first sign of something else - a viral or bacterial gastroenteritis, a urinary tract infection or sepsis, and among the metabolic causes diabetes insipidus, diabetic ketoacidosis and congenital adrenal hyperplasia. A vomiting child who is breathing deeply and passing large volumes of urine has diabetic ketoacidosis until a glucose says otherwise. RED FLAG - SHOCK IS A LATE SIGN, NOT AN EARLY ONE: by the time the blood pressure falls and the child is shocked, organ perfusion is already poor and emergency fluid resuscitation is needed. SEVERE DEHYDRATION IS AN INTRAVENOUS PROBLEM - a hypovolaemic child needs the volume back quickly: 20 mL/kg of isotonic saline (0.9% sodium chloride) intravenously over 20 minutes, repeated according to how the child then looks. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) That is a hospital, not a clinic. WATCH FOR LOW SUGAR IN THE CHILD WHO HAS NOT EATEN - blood tests in a dehydrated, vomiting child may show a low glucose alongside the electrolyte disturbance. DO NOT TRUST A SINGLE EXAMINATION TO GRADE IT - the article is explicit that no tool has been proven to establish how dehydrated a child is. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) Reassess, and weigh the child at every visit. PREVENTING THE NEXT ONE - vaccination against rotavirus, measles and cholera cuts the diarrhoeal illness behind most childhood dehydration. Clean water, better hygiene and proper sanitation - latrines, and handwashing - do the same at low cost. (Pediatric Dehydration - StatPearls - NCBI Bookshelf, NBK436022) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)