Page 2 of 2: paeds doubts

parin · Credits: 14540 My Scrapbook My Reading List 1 Books

Well, friends! What about hypokalemia? see this..

Hypochloraemic metabolic alkalosis--> increase pH is there
There is total body K deficit, but usually s. K levels are maintained--> so to maintain s. K, urine K is decreased..
Pre-op: i.v. fluids are continued until the infant is rehydrated & s. HCO3 is < 30 mEq/L, which implies that the alkalosis has been corrected--> increase HCO3 is there

So answer could be hypokalemia?

Incidence:

3:1000 in US
males affected more
1st borns are affected more
increased in BGs B & O

Aeitiology:

usually not present at birth, never in still births, so develops after birth..

abnormal muscle innervation, elevated serum prostaglandins, reduced pyloric NO synthetase levels. etc are implicated..

Associations:
Tracheo-esophageal fistula
Eosinophilic gastroenteritis
Edward syndrome
Apert syndrome
Zellweger syndrome
Smith-Lemli-Opitz syndrome
Cornelia de Lange syndrome

Its association is also with use of erythromycin & i.v. prostaglandins..

C/F:

Nonbilious vomitting, progressive & occurs immediately after each feeding, projectile, usually stars in 3rd wk, but varies from 1st wk to 5 months..
Hypochloraemic metabolic alkalosis
There is total body K deficit, but usually s. K levels are maintained..
In 5% there is jaundice d/t decrease glucuronyl transferase levels, which is corrected after treatment of obstruction..

O/E- a mass located above & to right of the umbilicus in midepigastrium beneath the liver edge, firm, moveable, approx 2 cm in length, olive shaped, best palpable from left side...

visible peristaltic wave from left to right after feeding..

Diagnosis:

USG criteria for diagnosis: pyloric thickness > 4 mm or an overall pyloric length > 14 mm

Barium studies:
- elongated pyloric channel
- a bulge of the pyloric muscle into the antrum--shoulder sign
- parallel streaks of barium in the narrowed channel--Doublr traqct sign

Treatment:

Pre-op: i.v. fluids- 0.45-0.9% saline in 5-10% dextrose + 30-50 mEq/L KCl, continued until the infant is rehydrated & s. HCO3 is < 30 mEq/L, which implies that the alkalosis has been corrected..

Nasogastric suction if stomach is not empty..

Ramstedt pyloromyotomy
(operative mortality 0-0.5%, feedings are initiated within 12-24 hrs after surgery & maintainance oral feedings within 36-48 hours..)

prasad · Credits: 2257 My Scrapbook

ujwals · Credits: 4860 My Scrapbook

ans 4

Schwartz

These infants develop a metabolic alkalosis with severe depletion of potassium and chloride ions. The serum pH level is high, whereas the urine pH level is high initially but eventually drops as the severe potassium deficit leaves only hydrogen ions to exchange with sodium ions in the distal tubule of the kidney.

richa83 · Credits: 394 My Scrapbook

cmmonest cause of convulsion in a child with fever...febrile convulsion or meningitis

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