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Fluid resuscitation in infantile hypertrophic pyloric stenosis
H H Miozzari1, M Tönz, R O von Vigier
1Department of Pediatric Surgery, University of Bern, Switzerland.
Insights
Infants with pyloric stenosis often have metabolic alkalosis. Fluid resuscitation requires careful chloride administration to correct biochemical disturbances, guiding fluid volume based on alkalosis severity.
Area of Science:
- Pediatric Surgery
- Biochemistry
- Pediatric Gastroenterology
Background:
- Infantile hypertrophic pyloric stenosis is a common surgical condition in infants.
- Vomiting in infants leads to significant fluid and electrolyte imbalances.
- Accurate assessment of fluid deficits in these infants can be challenging.
Purpose of the Study:
- To investigate biochemical disturbances at presentation in infantile pyloric stenosis.
- To analyze the effects of initial fluid resuscitation before surgery.
- To establish correlations between fluid management and acid-base balance.
Main Methods:
- Retrospective chart review of 139 infants with hypertrophic pyloric stenosis.
- Analysis of biochemical parameters including electrolytes and acid-base balance.
- Correlation analysis between parenteral chloride dose and plasma bicarbonate changes.
Main Results:
- A trend towards hypokalemia, hypochloremia, and metabolic alkalosis was frequently observed on admission.
- A significant correlation was found between parenteral chloride dose and changes in plasma bicarbonate (r = 0.54, p < 0.001).
- Approximately 10 mmol/kg body weight of chloride is needed to decrease plasma bicarbonate by 3 mmol/L.
Conclusions:
- Metabolic alkalosis severity is a crucial indicator for determining fluid requirements in infants with pyloric stenosis.
- Accurate fluid resuscitation is essential for managing biochemical disturbances prior to surgical intervention.
- Clinical assessment of fluid volume can be unreliable; biochemical markers are vital.
Unlabelled:
The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive infants (113 boys and 26 girls) between 7 d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalaemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid-base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y = 0.310 x; r = 0.54; p < 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10 mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/.
Conclusion:
Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.