Pyloric Stenosis Fluid Resuscitation

The study is a retrospective review of 505 pyloric stenosis patients from Kansas City, with 202 having abnormal electrolytes.

The protocol aims to avoid randomly guessing fluid amounts, rechecking electrolytes, and giving more fluid in an iterative fashion.

Abnormal electrolytes were defined as chloride less than 100, bicarbonate greater than 30, and potassium greater than 5.2 or less than 3.1.

Fluid boluses were 20 cc per kilogram of normal saline.

Maintenance fluid between boluses was 1.5 cc per kilogram of D5 half normal saline, with 20 mEq of KCL added depending on potassium level and urine output.

If chloride is less than 85, give three 20 cc/kg normal saline boluses, then recheck labs.

If chloride is less than or equal to 97, give two normal saline boluses, then recheck labs.

If chloride is greater than 97 but bicarbonate is less than 33, give one normal saline bolus.

If chloride is normal but bicarbonate is greater than 40, give three normal saline boluses.

If chloride is normal but bicarbonate is greater than or equal to 33, give two normal saline boluses and recheck electrolytes.

If chloride and bicarbonate are normal but potassium is abnormal, give one normal saline bolus and recheck electrolytes.

If all electrolytes are normal, proceed to the operating room when the patient is physiologically appropriate.