Pre-Operative Care of Infants with Pyloric Stenosis
Introduction Classic presentation of a child with pyloric stenosis is as follows
Metabolic changes in Pyloric StenosisSignificant vomiting induces a loss of chloride as well as hydrogen ions, this leads to hypochloraemic metabolic alkalosis. Na+ re-absorption is one of the major functions of the kidney; Na+ is actively re-absorbed in preference to H+ and K+.The increased H+ loss results in acidic urine, an increased metabolic alkalosis and increased K+ loss (on top of the K+ loss due to vomiting). Hypokalaemia is not seen initially because of K+ shift from intracellular fluid to the ECF and dehydration. If K+ level are low before fluid replacement begins, then hypokalaemia will become worse if the rehydration fluid does not contain K+. Cardiac arrhythmias have occurred secondary to hypokalaemia in pyloric stenosis.
Definitions Pyloric stenosis
Care of an Infant with Pyloric Stenosis Referral Process
Initial Treatment
Fluid Regimen and Electrolyte Correction
Examinations
Investigations
Observations and Nursing considerations
Scope
Purpose It aims to provide best practice guidelines to ensure that, whenever an infant with pyloric stenosis is admitted, common standards are maintained.
Implementation Training and dissemination will be via the Wessex Surgical Network and the PIER website.
Process for Monitoring Effectiveness Effectiveness and adherence to the guideline will be monitored by audit of practice.
|