The significance of alkalosis and hypochloremia in hypertrophic pyloric stenosis

Breaux, Charles W.; Hood, J. S.; Georgeson, Keith E.

doi:10.1016/s0022-3468(89)80561-5

Cited by 23 publications

(20 citation statements)

References 2 publications

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“…The relationship between IHPS-induced metabolic alkalosis and respiratory depression has been described in a few small case series [2][3][4][5][6][7]. Our case series again highlights the possibility of profound hypoventilation with desaturations occurring as a result of the metabolic alkalosis of infantile hypertrophic pyloric stenosis.…”

Section: Resultssupporting

confidence: 63%

“…For many years this has not been a recognized cause of apneic events [8]. However, several case reports and small case series have emerged in the literature detailing profound hypoventilation due to the severe alkalosis of IHPS [2][3][4][5][6][7]. Reports in the adult literature have also come to similar conclusions in cases of gastric outlet obstruction and other causes of severe metabolic alkalosis [7,[9][10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…A few case reports exist in the literature regarding hypoventilation in patients with pyloric stenosis [2][3][4][5][6][7]. We report our experiences of patients with IHPS who had respiratory depression and required pediatric intensive care unit (PICU) admission.…”

Section: Introductionmentioning

confidence: 96%

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Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Jude

Ling²,

Ungern‐Sternberg

et al. 2016

JPNC

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Infantile hypertrophic pyloric stenosis (IHPS) results in electrolyte disturbances due to persistent vomiting. Though the significance of hyperventilation in metabolic acidosis is established, debate continues regarding hypoventilation in metabolic alkalosis. We present six cases of respiratory depression requiring ICU admission in infants with hypochloremic, hypokalemic metabolic alkalosis due to IHPS. Keywords:Infantile hypertrophic pyloric stenosis; Hypochloremic; Bronchiolitis; Hypoventilation; Alkalosis; Chemoreceptor; Hypochloremic debate continues regarding hypoventilation (i.e. compensatory respiratory acidosis) in metabolic alkalosis.A few case reports exist in the literature regarding hypoventilation in patients with pyloric stenosis [2][3][4][5][6][7]. We report our experiences of patients with IHPS who had respiratory depression and required pediatric intensive care unit (PICU) admission. We assessed the indications for PICU admissions for patients with IHPS over a 15 year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) at the state's only tertiary pediatric hospital. In particular, we were interested in the detrimental respiratory effects of severe metabolic alkalosis associated with prolonged vomiting in IHPS. Materials and MethodsA retrospective chart review was performed on patients with IHPS admitted into PICU at Princess Margaret Hospital for Children, between 2000 and 2014 inclusive. Charts were reviewed with special attention to presentation, oxygen requirements, apneas and bradypneas, blood results, operative reports, past medical history, investigation of alternative diagnoses, and management. Data entry was completed using Microsoft Excel. The hospital ethics committee approved this study. FindingsThe process for identification of cases for this series is detailed in Figure 1. This discussion will focus on the six cases admitted preoperatively with severe metabolic alkalosis and apneas and/or desaturations. Regarding the two other cases, one was admitted to PICU on day 2 for an acute pre-operative deterioration with massive hematemesis, and the second was admitted to PICU post-operatively for respiratory distress due to concurrent RSV bronchiolitis. This patient had a mixed picture of blood gases, with predominant respiratory acidosis. These cases will not be discussed further.Patient demographics are detailed in Table 1. All infants presented with persistent non-bilious vomiting after feeds, 5 of which had become projectile by presentation. At presentation, median chronological age 7.9 weeks (range: 4-12 weeks), corrected age 4.5 weeks (range: -0.5-12 weeks), and median weight 3.9kg (range: 2.7-4.2). Median duration of symptoms was 2.2 weeks (range: 0.5-6 weeks). Other symptoms included weight loss, reduced urine output (estimated by number of wet nappies), diarrhea, and constipation. On clinical assessment by emergency department physicians, all cases were documented as 'severely dehydrated' on admission.Two of the patients had po...

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Section: Resultssupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Jude

Ling²,

Ungern‐Sternberg

et al. 2016

JPNC

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“…[11][12][13] The degree of electrolyte abnormalities has been associated with the length of illness. [12][13][14][15] This analysis demonstrates that the aforementioned classical features of IHPS have decreased in frequency over time. The length of illness before admission declined during this study.…”

Section: Discussionmentioning

confidence: 64%

Evolution in the Recognition of Infantile Hypertrophic Pyloric Stenosis

Hulka

Campbell

Campbell³

et al. 1997

Pediatrics

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ABSTRACT. Purpose. To analyze changes in the clinical condition at presentation and methods of establishing the diagnosis of infantile hypertrophic pyloric stenosis (IHPS).Methods. Retrospective review of patients who underwent pyloromyotomy (PM) for suspected IHPS at two institutions from 1969 through 1994 was performed. For the purposes of comparison, the population was divided into five equal time periods.Results. Over the 25-year period, 901 infants underwent PM. Patients presented at a younger age, weighed more, and had a shorter length of illness in the most recent time period. Hypochloremic alkalosis was found half as frequently in the most recent time period compared to the earliest group. A palpable pyloric tumor was present in 79% of patients in the earliest time period compared with 23% in the most recent time period. Sixty-one percent of patients in the earliest group and 96% in the latest group underwent an imaging study, reflecting the referring physician's evaluation before referral to the surgeon.Conclusions. Currently, patients with IHPS less frequently present with the clinical hallmarks of the disease. The use of imaging studies to establish the diagnosis has become common practice. The result has been the diagnosis of IHPS before alkalosis has developed, a shorter clinical course, less morbidity, and a shorter postoperative hospital stay. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/ cgi/content/full/100/2/e9; pyloric stenosis, pyloromyotomy, diagnosis, hypochloremic alkalosis, upper gastrointestinal series, abdominal ultrasonography.ABBREVIATIONS. IHPS, infantile hypertrophic pyloric stenosis; UGI, upper gastrointestinal series; U/S, ultrasound; PM, pyloromyotomy; PLOS, preoperative length of stay; TLOS, total length of stay.T raditionally, the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) is based on a history of projectile, nonbilious vomiting, and palpation of a pyloric tumor.1,2 The presence of hypochloremic alkalosis has also been associated with IHPS.3 Infants with historical but not physical findings consistent with IHPS undergo radiologic evaluation by either upper gastrointestinal series (UGI) or, more recently, abdominal ultrasound (U/S) to establish the diagnosis. The increased reliance of radiologic tests to diagnose IHPS has been ascribed to inexperienced examiners not palpating a pyloric tumor and subsequently proceeding with further evaluation. 4 -6 To evaluate temporal trends in the presentation and methods of diagnosis of IHPS, we performed a review of patients who underwent pyloromyotomy (PM) in the past 25 years. PATIENTS AND METHODSA retrospective chart review of patients who underwent PM for suspected IHPS at two teaching institutions between 1969 and 1994 was performed. All patients were examined and subsequently operated on by one of the authors (T.J.C., J.R.C., M.W.H.). Only patients with confirmed IHPS at the time of surgery were included in this analysis. Data included demographic information, history of illness, physical findings, admission...

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“…The affected infants may be dehydrated and/or lethargic. The presence of the classical hypochloremic metabolic alkalosis aids in the diagnosis, but it is not always present in PS [6][7][8]. Although palpation of the pyloric mass (olive) is diagnostic, it may be not detected in 11 % to 51 % of cases [9,10].…”

Section: Discussionmentioning

confidence: 99%

Is There a Relation Between Pyloric Muscle Thickness and Clinical and Laboratory Data in Infants with Hypertrophic Pyloric Stenosis?

Almaramhy

2013

Indian J Surg

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Literature about the association between clinical and laboratory presentation and pyloric muscle thickness in infants with pyloric stenosis is lacking. The objective of this study is to examine the effect of pyloric muscle thickness on clinical and laboratory presentation in infants with pyloric stenosis. Thirty infants with hypertrophic pyloric stenosis presented at the Maternity and Children Hospital, AlMadinah, Saudi Arabia, were included in this study analysis. Clinical and laboratory data of these infants were recorded. Statistical tests and univariate linear regression analyses were used as appropriate. P value was considered significant at a level ≤0.05. The mean age of the studied infant was 5.1± 2.6 weeks and mean weight was 3.4±0.7 kg. Most of these infants were full-term (93.3 %), some presented to the hospital dehydrated (80 %), and some were lethargic (56.7 %). The mean pyloric muscle thickness among these infants showed statistically significant difference with regard to the studied clinical and laboratory data. A linear regression analyses also showed positive association between increasing pyloric muscle thickness and almost all studied clinical and laboratory data, with statistically significant difference observed for hyponatremia, hypochloremia, and high bicarbonates. The findings suggest that pyloric muscle thickness is a significant factor that determines the severity of clinical and laboratory presentation in infants with pyloric stenosis.

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The significance of alkalosis and hypochloremia in hypertrophic pyloric stenosis

Cited by 23 publications

References 2 publications

Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Evolution in the Recognition of Infantile Hypertrophic Pyloric Stenosis

Is There a Relation Between Pyloric Muscle Thickness and Clinical and Laboratory Data in Infants with Hypertrophic Pyloric Stenosis?

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