What is included in emergency care of pediatric pyloric stenosis?

Updated: Nov 13, 2018
  • Author: Sathyaseelan Subramaniam, MD, FAAP; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

See the list below:

  • Infantile hypertrophic pyloric stenosis (IHPS) may be described as a medical emergency or a medical urgency based on how early in the course the patient presents.
  • If significant dehydration has occurred, immediate treatment requires correction of fluid loss, electrolytes, and acid-base imbalance, starting with an initial fluid bolus (20ml/kg) of isotonic crystalloid.
  • More than 60% of infants present to the ED with normal electrolyte values and are not significantly dehydrated. These infants should receive 1.5-2 times maintenance intravenous fluid: 5% dextrose in 0.45% normal saline with 20mEq/l of potassium chloride replacement. The infant's fluid status should be continuously reassessed with special attention to acid-base status and urine output.
  • A request for pyloric ultrasound should be made for definitive diagnosis of pyloric stenosis.  This is not emergent and may be performed after the patient is stabilized and as an in-patient as well.
  • The definitive treatment for infantile hypertrophic pyloric stenosis is corrective surgery, thus once the diagnosis has been confirmed, a pediatric surgeon should be consulted.

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