MedBalans

First-line therapy

IV fluid and electrolyte correction BEFORE surgical referral • —

Duration: Until transfer / definitive care · ABCDE; NPO; correct dehydration and hypochloremic alkalosis with isotonic IV fluids (0.9% NaCl ± KCl per labs); monitor urine output and electrolytes; urgent pediatric surgery consult for pyloromyotomy — NOT simple GER

Clinical notes

• Recognition: onset 2–8 weeks, non-bilious projectile vomiting, weight loss, visible peristalsis, hypochloremic alkalosis on BMP — ultrasound confirms thickened pylorus.

• Primary care critical step: IV rehydration and electrolyte correction BEFORE surgery — operating on uncorrected alkalosis increases anesthesia risk.
• Do NOT: misdiagnose as GER and discharge; give oral feeds; rush to OR without labs/fluid resuscitation.
• After stabilization: semi-urgent pyloromyotomy (Ramstedt) — excellent outcomes when electrolytes normalized.
• Bilious vomiting suggests alternative diagnosis (malrotation) — do not attribute to pyloric stenosis.

Hypertrophic Pyloric Stenosis

First-line therapy

Clinical notes