Pyloric stenosis: Fluid therapy
Pyloric stenosis is a medical emergency, not a surgical emergency. The patient should not be operated on until there has been adequate fluid and electrolyte resuscitation. According to Barash, the infant should have normal skin turgor, and the correction of the electrolyte imbalance should produce a sodium level that is >130 mEq/L, a potassium level that is at least 3 mEq/L, a chloride level that is >85 mEq/L and increasing, and a urine output of at least 1 to 2 mL/kg/hr. These patients need a resuscitation fluid of full-strength, balanced salt solution and, after the infant begins to urinate, the addition of potassium.
According to Smith, “The initial therapeutic approach is aimed at repletion of intravascular volume and correction of electrolyte and acid-base abnormalities (e.g., 5% dextrose in 0.45% NaCl with 40 mmol/L of potassium infused at 3 L/m2 per 24 hours). Most children respond to therapy within 12 to 48 hours, after which surgical correction can proceed in a nonemergent manner. The use of cimetidine has also been shown to rapidly normalize the metabolic alkalosis in patients with hypertrophic pyloric stenosis."