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

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 st 3 HCO − 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 st 3 HCO − 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 m 2 ). 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.

Do Immaturity, Dehydratation or Alkalosis Predispose to Intraoperative Complications at Pyloromyotomy?

“…Complicative Reference average in the normal range (4.5 -6.5 kPa) with 5.5 to 5.7 kPa (p = 0.60). We only observed a measurable respiratory depression in one patient of the comparison group [13] [22] [23]. The lactate as a measure of anaerobic metabolism and liver clearance were also the same for both groups (p = 0.96).…”

“…In our previous study, we were able to show that a statistically significant negative correlation between haemoglobin concentration in the blood and the postnatal age exists for infants with IHPS [13]. Smaller infants with a time interval from the nadir of trimester anaemia still showed higher haemoglobin.…”

“…The biometric and biochemical parameters were compiled using routine diagnostics on the occasion of inpatient admission of the children and before infusion therapy. We compared the date of the Complicative group with an independently published normal group of 56 children from our department [13].…”

Review. Gastrointestinal Surgery in Neonates: Practice, Facts, and Trends

“…With a prevalence of 1:300, pyloric stenosis is 10 to 15 times more common than Preoperatively, both fluid loss and alkalosis are compensated by infusion of a balanced isotonic infusion solution with 5% glucose [43]. It should be noted that some neonates suffer from respiratory depression as a result of alkalosis (pulse oximetry) [44].…”

Difference between Hypertrophic Pyloric Stenosis in Child with History of Prematurity and Aterm

“…The most common risk factors are family history, gender, younger maternal age, being a first born infant, and pattern of feeding. [6][7][8] There are many modalities to help make the . 5,10 The purpose of this case presentation to report a case of Hypertrophic pyloric stenosis from two patients, first patient with aterm baby, another patient with preterm baby, onset of HPS in both patient is same, in the fifth week of life.…”