TYK389

A 6 week old 3.6 kg male infant is scheduled for emergent laparoscopy for a history of projectile emesis. On exam, the infant has a heart rate of 189, a blood pressure of 68/46, temperature of 37.1, respiratory rate of 32 and appears lethargic. The most appropriate management at this point is

a) Emergency laparoscopy to determine the cause of emesis

b) Fluid bolus of 20 mL/kg with normal saline

c) Fluid bolus of 20 mL/kg with D5W

d) Administration of maintenance intravenous fluids at 14.4 mL/hr

e) Oral electrolyte solution

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Answer

Answer b. This infant most likely has pyloric stenosis, which is a medical emergency, NOT a surgical emergency. The most appropriate management is intravenous resuscitation with normal saline via peripheral venous or intraosseous access. Dextrose containing solutions should not be bolused intravenously. While oral electrolyte solution may be appropriate for treatment of dehydration in select patients, this condition is usually not amenable to oral hydration. Serum bicarbonate less than 30 is often a good marker for adequate rehydration in these patients.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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