15: Two siblings: 4-year-old male and 8-week old male with vomiting

Question 1

What would abdominal pain with low chloride, low K, and metabolic alkalosis indicate?

Answer 1

Pyloric stenosis

Question 2

Why is NS the best bolus therapy for severe dehydration in pyloric stenosis?

Answer 2

Because it doesn’t contain lactate (a base which could worsen the alkalosis)

Question 3

What’s the normal amount for fluid boluses?

Answer 3

10-20mL/kg

Question 4

How do you calculate maintenance fluids?

Answer 4

First 10kg: 4mL/kg/hr
Second 10kg: 2mL/kg/hr
Any additional kg: 1mL/kg/hr

Question 5

What condition might be present if bilious emesis is occurring?

Answer 5

Volvulus

Question 6

What are the 3 best tests for pyloric stenosis?

Answer 6

1. Pyloric US
2. Upper GI contrast study
3. Electrolytes

Question 7

What does the “string sign” represent?

Answer 7

Pyloric stenosis

Question 8

What’s the tx for pyloric stenosis?

Answer 8

Surgery

Question 9

Does pyloric stenosis often present with projectile non-bilious vomiting?

Answer 9

Yes

Question 10

What condition presents with bilious emesis, severe intermittent abdominal pain, and current jelly stools?

Answer 10

Intussusception