Pathophysiology of Hypertrophic Pyloric Stenosis Revisited: The Use of Isotonic Fluid for Preoperative Infusion Therapy Is Supported


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.

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Troebs, R. (2014) Pathophysiology of Hypertrophic Pyloric Stenosis Revisited: The Use of Isotonic Fluid for Preoperative Infusion Therapy Is Supported. Open Journal of Pediatrics, 4, 208-215. doi: 10.4236/ojped.2014.43027.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Laffolie, J., Turial, S., Heckmann, M., et al. (2012) Decline in Infantile Hypertrophic Pyloric Stenosis in Germany in 2000-2008. Pediatrics, 129, e901-e906.
[2] Glatstein, M., Carbell, G., Boddu, S.K., et al. (2011) The Changing Clinical Presentation of Hypertrophic Pyloric Stenosis: The Experience of a Large, Tertiary Care Pediatric Hospital. Clinical Pediatrics, 50, 192-195.
[3] Clark, R.G. and Norman, J.N. (1964) Metabolic Alkalosis in Pyloric Stenosis. Lancet, 1, 1244-1245.
[4] Dawson, K.P. and Graham, D. (1991) The Assessment of Dehydratation in Congenital Pyloric Stenosis. The New Zealand Medical Journal, 104, 162-163.
[5] Rogers, I.M. (2006) The True Cause of Pyloric Stenosis Is Hyperacidity. Acta Paediatrica, 95, 132-136.
[6] Foster, B.A., Tom, D. and Hill, V. (2014) Hypotonic versus Isotonic Fluids in Hospitalized Children: A Systematic Review and Meta-Analysis. The Journal of Pediatrics, 165, 163-169.
[7] Bianchetti, M.G. and Bettinelli, A. (2008) Differential Diagnosis and Management of Fluid, Electrolyte, and Acid-Base Disorders. In: Geary, D.F. and Schaefer, F., Eds., Comprehensive Pediatric Nephrology. Mosby/Elsevier, Philadelphia.
[8] Fox, G., Hoque, N. and Watts, T. (2010) Oxford Handbook of Neonatology. Oxford University Press, Oxford, New York.
[9] Graham, D.A., Mogride, N., Abbott, G.D., et al. (1993) Pyloric Stenosis: The Christchurch Experience. The New Zealand Medical Journal, 106, 57-59.
[10] Khajuria, A. and Krahn, J. (2005) Osmolality Revisited—Deriving and Validating the Best Formula for Calculated Osmolality. Clinical Biochemistry, 38, 514-519.
[11] Hogg, R.J., Furth, S., Lemley, K.V., et al. (2003) National Kidney Foundation’s Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: Evaluation, Classification and Stratification. Pediatrics, 111, 1416-1421.
[12] Tan, S. and Campbell, M. (2008) Acid-Base Physiology and Blood Gas Interpretation in the Neonate. Paediatrics and Child Health, 18, 172-177.
[13] Beasley, S.W., Hudson, I., Hok Pan, Y., et al. (1986) Influence of Age, Sex, Duration of Symptoms and Dehydration of Serum Electrolytes in Hypertrophic Pyloric Stenosis. Australian Paediatric Journal, 22, 193-197.
[14] Feng, Z., Nie, Y., Zhang, Y., et al. (2010) The Clinical Features of Infantile Hypertrophic Pyloric Stenosis in Chinese Han Population: Analysis from 1998 to 2010. PloS ONE, 9, e88925.
[15] Shanbhogue, L.K.R., Sikdar, T., Jackson, M., et al. (1992) Serum Electrolytes and Capillary Blood Gases in the Management of Hypertrophic Pyloric Stenosis. British Journal of Surgery, 79, 251-253.
[16] Touloukian, R.J. and Higgins, E. (1983) The Spectrum of Serum Electrolytes in Hypertrophic Pyloric Stenosis. Journal of Pediatric Surgery, 18, 394-397.
[17] Czeizel, A. (1972) Birthweight Distribution in Congenital Pyloric Stenosis. Archives of Disease in Childhood, 47, 978-980.
[18] Doenecke, D., Koolman, J., Fuchs, G., et al. (2005) Karlsons Biochemie und Pathobiochemie. Georg Thieme Verlag, Stuttgart, New York.
[19] Muntau, A.C. (2007) Intensivkurs Padiatrie. Urban & Fischer, München.
[20] Saba, T.G., Fairbairn, J., Houghton, F., et al. (2011) A Randomized Controlled Trial of Isotonic versus Hypotonic Maintenance Intravenous Fluids in Hospitalized Children. BMC Pediatrics, 11, 82.
[21] Lehnert, W., Schenck, W. and Niederhoff, H. (1979) Isovaleric Acidemia Combined with Hypertrophic Pyloric Stenosis. Klinische P?diatrie, 191, 477-482.
[22] Shumake, L.B. (1975) Postoperative Hypoglycemia in Congenital Hypertrophic Pyloric Stenosis. Southern Medical Journal, 68, 223-224.
[23] Roman, A. and Burmeister, W. (1978) Hypokalemia in Infants Due to Disturbed Salt, Water and Acid-Base Balance. Klinische P?diatrie, 190, 108-117.
[24] Lorenz, J.M. (2008) Potassium Metabolism. In: Oh, W., Guignard, J.P. and Baumgart, S., Eds., Nephrology and Fluid/Electrolyte Physiology: Neonatal Questions and Controversies, 2nd Edition, Saunders/Elsevier, Philadelphia, 54-65.
[25] Pappano, D. (2011) Alkalosis-Induced Respiratory Depression from Infantile Hypertrophic Pyloric Stenosis. Pediatric Emergency Care, 27, 124.
[26] Tigges, C.R. and Bigham, M.T. (2012) Hypertrophic Pyloric Stenosis: It Can Take Your Breath Away. Air Medical Journal, 1, 45-48.
[27] Smith, G.A., Mihalov, L. and Shields, B.J. (1999) Diagnostic Aids in the Differentiation of Pyloric Stenosis from Severe Gastroesophageal Reflux during Early Infancy: The Utility of Serum Bicarbonate and Serum Chloride. The American Journal of Emergency Medicine, 17, 28-31.
[28] Henderson, B.M., Schubert, W.K., Hug, G., et al. (1968) Hypoglycemia with Hepatic Glycogen Depletion: A Postoperative Complication of Pyloric Stenosis. Journal of Pediatric Surgery, 3, 309-316.
[29] Pierro, A., De Coppi, P. and Eaton, S. (2012) Neonatal Physiology and Metabolic Considerations. In: Coran, A.G., Adzik, N.S., Krummel, T.M., et al., Eds., Pediatric Surgery, 7th Edition, Elsevier/Saunders, Philadelphia, 89-107.
[30] Dutta, S., Lodha, R., Kabra, M., et al. (2000) Persistent Hypoglycemia with Pyloric Stenosis. Indian Pediatrics, 37, 890-893.

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