A 5-week-old boy is admitted after a fortnight of vomiting that now shoots across the change table after every…

Question

A 5-week-old boy is admitted after a fortnight of vomiting that now shoots across the change table after every feed. The vomit has never been green. He feeds hungrily, has lost 200 g since birth and has a sunken fontanelle. Ultrasound has confirmed hypertrophic pyloric stenosis and the surgical registrar has accepted him. Venous blood gas shows pH 7.52, bicarbonate 34 mmol/L, chloride 88 mmol/L (95 to 110) and potassium 3.0 mmol/L (3.5 to 5.5). Which one of the following should be done next?

Accepted Answer

Commence intravenous sodium chloride with potassium

Answer

Book the emergency theatre for pyloromyotomy

Answer

Insert a nasogastric tube for free drainage

Answer

Repeat the venous blood gas in six hours

Answer

Withhold oral feeds and observe overnight

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