In Hypertrophic pyloric stenosis which electrolyte should be replenished?
ANSWER: (B) K+REF: With textHypertrophic pyloric stenosis presents with hyponatremic, hypokalemic, hypochloremic metabolic alkalosis with paradoxical aciduriaSchwartz 9th ed chapter 3, 39: Treatment includes replacement of the volume deficit with isotonic saline and then potassium replacement once adequate urine output is achieved. Fluid resuscitation with correction of electrolyte abnormalities and metabolic alkalosis is essential before induction of general anesthesia for operation. For most infants, administration of fluid containing 5% dextrose and 0.45% saline with 2 to 4 mEq/kg of added potassium at a rate of approximately 150 to 175 mL/kg for 24 hours will correct the underlying deficit. After resuscitation, a Fredet-Ramstedt pyloromyotomy is performedSabiston 18tk ed ch 71 states: The definitive treatment of choice is pyloromyotomy. But Before surgery, it is important that the infant is hydrated with IV fluids to establish a normal urine output. It is important that the underlying metabolic alkalosis is slowly corrected with normal saline. Potassium is not given until the intravascular volume has been restored and normal urine output has resumed.Nelson 's 18th ed ch:326.1 states that: The preoperative treatment is directed toward correcting the fluid, add-base, and electrolyte losses. Intravenous fluid therapy is begun with 0.45- 0.9% saline, in 5-10% dextrose, with the addition of potassium chloride in concentrations of 30-50 mEq/L. Fluid therapy should be continued until the infant is rehydrated and the serum bicarbonate concentration is <30 mEq/dL, which implies that the alkalosis has been corrected.
Na+
K+
C1--
HCO3--
Stomach and Intestines