Laboratory Abnormalities and Pyloric Stenosis

The classic clinical presentation of infantile hypertrophic pyloric stenosis (IHPS) is an emaciated 3- to 6-week-old infant who has been experiencing immediate postprandial, nonbilious, projectile vomiting over a period of weeks. The infants remain hungry and demand to be re-fed after vomiting. Caucasian, full-term boys (4:1 to 6:1) tend to present with this condition most frequently, and these patients tend to be firstborns. An olive-sized tumor can be felt to the right of the umbilicus, and this may best be palpable immediately after the infant has vomited. Visible peristaltic waves may also be noted. The infants are typically not otherwise ill-appearing, but they may be dehydrated with fretfulness, apathy, and loss of skin turgor. Click here to watch a video of a patient with pyloric stenosis. The frequent and persistent vomiting puts these infants at risk for electrolyte abnormalities, specifically hypochloremia, hypokalemia, and metabolic alkalosis. Interestingly, the classic presentation of this condition would probably not include electrolyte abnormalities; they tend to be absent in the majority of patients studied. (Am J Emerg Med 1999;17[1]:67; Pediatr Emerg Care 2013;29[4]:465; J Pediatr Surg 1989;24[12]:1250.) Significant electrolyte abnormalities tend to occur in infants undiagnosed for more than three weeks. Fortunately, infants are currently diagnosed earlier than in the past, and they tend to be less emaciated. Normal laboratory values are the most common find...
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