TITLE:
Pathophysiology of Hypertrophic Pyloric Stenosis Revisited: The Use of Isotonic Fluid for Preoperative Infusion Therapy Is Supported
AUTHORS:
Ralf-Bodo Troebs
KEYWORDS:
Infantile Pyloric Stenosis, Metabolic Alkalosis, Dehydration, Osmolality, Glucose, Lactate, Creatinine Clearance, Infusion Therapy
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.3,
September
3,
2014
ABSTRACT: Background: The aim of this study was to elucidate the
preoperative clinical and biochemical profile of infants with IHPS to optimize
infusion therapy. Patients and Method: We retrospectively analyzed data from 56
infants who were operated for IHPS. Our study includes growth and laboratory
data prior to the initiation of therapy. Results: Median duration of propulsive
vomiting was 4 d; the median age was 37 d (18 - 108), and the median body
weight was 3840 g (2760 -5900). Metabolic alkalosis (MAlk) with a pH of 7.45 ± 0.06
and an stHCO3- of 28.7 ± 4.5 mmol/l was found. In a subgroup of the
infants, negative base excess (BE) was observed. The sodium concentration was
normal or reduced (mean/median of 137 mmol/l). There was a strong negative
correlation between stHCO3- and K+. The carbon dioxide
partial pressure tended to increase (5.72 ± 0.84 kPa). Calculations of
osmolality revealed a normal osmolarity. Hypoglycemia did not occur. The
creatinine clearance according to the Schwartz formula remained at a normal
level (85.3 ± 24.3 ml/min/1.73 m2). Discussion: The presented case
series is characterized by a short duration of preoperative vomiting. MAlk can
be classified as a chloride deficiency syndrome. It is accompanied by normo- or
hyponatremic dehydration with normal osmolality. Partial respiratory
compensation occurred. A normal creatinine clearance indicated good glomerular
renal function. Conclusion: The presented study supports the use of an isotonic
infusion fluid with a low glucose concentration for preoperative infusion
therapy.