A 3 weeks old patient presenting with vomiting and failure to thrive is found to have pyloric stenosis. What should be the next step of management? (AIPG 2010)
|B||Correction of electrolyte disturbances & surgery can be delayed|
a. Pyloric stenosis is never a surgical emergency, although dehydration and electrolyte abnormalities may present a medical emergency.
b. Fluid resuscitation with correction of electrolyte abnormalities and metabolic alkalosis is essential before induction of general anesthesia for surgery.
c. For most infants, fluid containing 5% dextrose and 0.45% saline with added potassium of 2 to 4 mEq/kg given at a rate of approximately 150 to 175 mL/kg for 24 hours will correct the underlying deficit. It is important to ensure that the child has an adequate urine output (>1 mL/kg per hour) as further evidence that rehydration has occurred.
d. After resuscitation, a Fredet-Ramstedt pyloromyotomy is performed . It may be performed using an open or laparoscopic approach.
e. Since patient is failure to thrive hence resuscitation should be done first.