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Pyloric Stenosis (How would you assess hydration status? (Exam (GCS,…
Pyloric Stenosis
How would you assess hydration status?
History
Vomiting frequency, volumes, duration
Wet nappies, feeding
behavioural change
Exam
GCS
Sunken fontanelle, sunken eyes, red skin turgor
Signs only if >5% fluid loss
Shock - haemodyn instab, cold skin, reduced GCS, low UO
Weight loss only objective measure
Investigations
U+Es, FBC,
Detail and justify your resus regimen
Fluid Resuscitation
Baaed on weight loss and clinical signs
Resuscitation - N Saline or 4% Albumin bolus 20ml/kg if shocked or severely dehydrated
Maintenance - 045% saline with 5% glucose at 4ml/kg/hr. Add K 10mmol per 500ml when UO confirmed. Correction dehydration/electrolytes may take 48hrs
Ongoing losses - replacement NG loss with 0.9% NS
This is a medical emergency not a surgical emergency. Surgery caqn wait until electrrolytes and fluid balance normalised.
Preparation
IV access
Urinary catheter