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Plasma chloride and alkalaemia in pyloric stenosis
Insights
Plasma chloride levels reliably assess acid-base status in infantile hypertrophic pyloric stenosis. Achieving a plasma chloride concentration of at least 106 mmol/l is crucial for correcting alkalaemia.
Area of Science:
- Pediatric Gastroenterology
- Clinical Chemistry
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) frequently causes electrolyte and acid-base disturbances.
- Accurate assessment of acid-base status is vital for managing IHPS patients.
Purpose of the Study:
- To evaluate the reliability of plasma chloride estimation in assessing and correcting acid-base status in infants with IHPS.
- To determine the target plasma chloride concentration for achieving normoacidaemia.
Main Methods:
- Prospective study of 50 infants with IHPS.
- Analysis of plasma chloride concentrations on admission and during correction of alkalaemia.
- Exclusion of 4 cases due to protocol breach, leaving 46 cases for analysis.
Main Results:
- On admission, 17 infants (37%) were normoacidaemic and 29 (63%) were alkalaemic.
- Among alkalaemic infants, 23 had plasma chloride < 100 mmol/l.
- Normoacidaemia was achieved in 72% of cases when plasma chloride reached ≥ 106 mmol/l, and in 28% when it was 100-105 mmol/l.
Conclusions:
- Plasma chloride estimation is a reliable indicator for assessing and correcting alkalaemia in IHPS.
- A target plasma chloride concentration of at least 106 mmol/l is recommended for successful correction of alkalaemia in IHPS.
Abstract:
Fifty infants with infantile hypertrophic pyloric stenosis were studied prospectively to evaluate the reliability of plasma chloride estimation in the assessment of the acid-base status on admission and during correction of alkalaemia. Four cases were subsequently excluded because of a breach of the study protocol, leaving 46 cases in the study. Seventeen (37 per cent) were normoacidaemic on admission; 13 had plasma chloride concentrations of greater than or equal to 106 mmol/l and four had chloride concentrations of 100-105 mmol/l on admission. Twenty-nine (63 per cent) were alkalaemic on admission; six cases had chloride concentrations of 100-105 mmol/l and 23 cases had concentrations of less than 100 mmol/l. Of those 29 cases requiring correction of alkalaemia, normoacidaemia was achieved at a plasma chloride concentration of greater than or equal to 106 mmol/l in 21 cases (72 per cent) and at a concentration of 100-105 mmol/l in eight cases (28 per cent). Plasma chloride is a reliable parameter in the assessment and correction of alkalaemia in infantile hypertrophic pyloric stenosis provided that a concentration of at least 106 mmol/l is the goal.