Pyloric Stenosis Fluid Resuscitation
Timestops (6)
Tools Used
Topic Overview
Key Takeaways
- Chloride <85 requires 3 boluses of 20cc/kg NS; chloride ≤97 requires 2 boluses before rechecking labs
- Bicarbonate >40 requires 3 NS boluses; bicarb ≥33 requires 2 boluses regardless of chloride if chloride normal
- Maintenance fluid between boluses: 1.5cc/kg/hr D5 half-normal saline with 20mEq/L KCl based on potassium and urine output
- Algorithm prioritizes chloride correction first, then bicarbonate, then potassium to avoid repeated lab checks
- Normal electrolytes defined as chloride ≥100, bicarbonate ≤30, potassium 3.1-5.2 before proceeding to OR
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Transcript
This is Todd Ponsky reviewing another article for the Journal of Pediatric Surgery. Today we're going to review an article entitled Optimizing Fluid Resuscitation for Hypertrophic pyloric stenosis. First author is Doctor Brian Dalton. The senior author is Doctor Sean Saint Peter. Yet another fantastic paper from the group at Kansas City. I love this article. This article is a retrospective review that helps to define how much fluid we should be giving patients with abnormal electrolytes. The purpose is to try to avoid the problem of randomly guessing how much fluid to give, rechecking electrolytes, and then giving more fluid. What they did is retrospectively look at 505 patients, 202 of which had abnormal electrolytes. They defined abnormal as a chloride less than 100, a bicarb greater than 30, and a potassium greater than 5.2 or less than 3.1. The boluss they gave in this study were 20 cc per kilo boluss of normal saline. While the patients were not receiving a bolus, they were held on maintenance fluid of 1.5 ccs per kilo of D5 half normal saline. 20 of KCL was added to that maintenance fluid depending on if their potassium was abnormal and based on their urine output. And what they did is they looked to see how much fluid ended up being required to resuscitate patients, and they did this by the severity of their electrolyte abnormalities. So here's what they found. The first thing they did is always look at just the chloride. If the chloride was abnormal and less than 85, they gave three normal saline boluss of 20 ccs per kg, then they rechecked the labs. If the chloride was less than or equal to 97, they gave two normal saline boluss and then rechecked the labs. If the chloride was greater than 97 but the bicarb was less than 33, they gave one bolus of normal saline. If the chloride was normal, then they look at the bicarb. If the bicarb was greater than 40. Then they gave 3 normal saline boluss. If the bicarb were greater equal to 33, then they gave 2 normal saline boluss and rechecked the electrolytes. So if the chloride and the bicarb are normal, but the potassium is abnormal, then they gave one normal saline bolus and rechecked the electrolytes. If the electrolytes were normal, then they just took the patient to the operating room when the patient was physiologically appropriate. I thought this was a great study. We hope you enjoyed this review. I want to thank Ian Glenn for help in putting this review together. Please leave comments below and let us know any other studies you'd like us to review. Thanks.