Postoperative hypoglycemia in congenital hypertrophic pyloric stenosis

One infant with congenital hypertrophic pyloric stenosis developed severe hypoglycemia with lethargy, irritability, cyanosis, and convulsions in the immediate postoperative period after Fredet-Ramstedt pyloromytomy. A likely hypothesis for this mechanism has been reported as hepatic glycogen depletion secondary to malnutrition. Any infant with malnutrition, from whatever cause, should be assumed to have glycogen depletion, and repletion should be started and continued with all intravenous fluids given during the preoperative period. Hypoglycemia should be suspected when an infant develops any unusual or unexplained symptoms or findings in the immediate postoperative period. Prompt and intensive treatment with intravenous hypertonic glucose infusion must be begun and continued until blood glucose determinations remain at a safe level with oral feedings alone.