From
StayCurrentMD
Pyloric Stenosis Guideline Recap
With Dr. Meera Kotagal
Part of
Pyloric Stenosis 9 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Pyloric stenosis presents with progressive nonbilious emesis and sometimes a palpable olive in the epigastrium.
Labs in pyloric stenosis most often demonstrate a hypochloremic, hypokalemic metabolic alkalosis.
Ultrasound criteria for pyloric stenosis are muscle width greater than 3 millimeters and length greater than 14 millimeters.
Maintenance IV fluid is started at one and a half times the maintenance rate in pyloric stenosis patients.
Potassium is added to IV fluids once urine output has been confirmed.
There is a trend in the literature that isotonic fluids should be used instead of hypotonic fluids in pediatric patients, though evidence is still developing in this age population.
Patients go to the OR for pyloromyotomy once their bicarb level is less than 30, their chloride is greater than 100, and their potassium is normal.
Postoperative management includes a short NPO period of around two hours followed by ad lib feeding with breast milk or formula.
The Dalton et al. framework from Kansas City predicts the number of fluid boluses needed based on the original chloride level, so labs do not need to be rechecked between each bolus in children likely to require two or three saline boluses.
Randomized controlled trials by Markel et al. and Adebe et al. found that ad lib feeding compared to protocolized feeding is associated with equivalent or shorter hospital stays.
Ad lib feeding may result in more emesis but there were no complications associated with that emesis in the Markel and Adebe trials.