Infantile hypertrophic pyloric stenosis (IHPS): it can take away your breath, alertness, wee and poo

Patel, Ramnik V; Wockenforth, R; Milliken, Irene; Marshall, David F.

doi:10.1136/bcr-2013-201435

Cited by 5 publications

(13 citation statements)

References 3 publications

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“…For many years this has not been a recognized cause of apneic events [8]. However, several case reports and small case series have emerged in the literature detailing profound hypoventilation due to the severe alkalosis of IHPS [2][3][4][5][6][7]. Reports in the adult literature have also come to similar conclusions in cases of gastric outlet obstruction and other causes of severe metabolic alkalosis [7,[9][10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 58%

“…The relationship between IHPS-induced metabolic alkalosis and respiratory depression has been described in a few small case series [2][3][4][5][6][7]. Our case series again highlights the possibility of profound hypoventilation with desaturations occurring as a result of the metabolic alkalosis of infantile hypertrophic pyloric stenosis.…”

Section: Resultsmentioning

confidence: 63%

“…A few case reports exist in the literature regarding hypoventilation in patients with pyloric stenosis [2][3][4][5][6][7]. We report our experiences of patients with IHPS who had respiratory depression and required pediatric intensive care unit (PICU) admission.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Jude

Ling²,

Ungern‐Sternberg

et al. 2016

JPNC

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Infantile hypertrophic pyloric stenosis (IHPS) results in electrolyte disturbances due to persistent vomiting. Though the significance of hyperventilation in metabolic acidosis is established, debate continues regarding hypoventilation in metabolic alkalosis. We present six cases of respiratory depression requiring ICU admission in infants with hypochloremic, hypokalemic metabolic alkalosis due to IHPS. Keywords:Infantile hypertrophic pyloric stenosis; Hypochloremic; Bronchiolitis; Hypoventilation; Alkalosis; Chemoreceptor; Hypochloremic debate continues regarding hypoventilation (i.e. compensatory respiratory acidosis) in metabolic alkalosis.A few case reports exist in the literature regarding hypoventilation in patients with pyloric stenosis [2][3][4][5][6][7]. We report our experiences of patients with IHPS who had respiratory depression and required pediatric intensive care unit (PICU) admission. We assessed the indications for PICU admissions for patients with IHPS over a 15 year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) at the state's only tertiary pediatric hospital. In particular, we were interested in the detrimental respiratory effects of severe metabolic alkalosis associated with prolonged vomiting in IHPS. Materials and MethodsA retrospective chart review was performed on patients with IHPS admitted into PICU at Princess Margaret Hospital for Children, between 2000 and 2014 inclusive. Charts were reviewed with special attention to presentation, oxygen requirements, apneas and bradypneas, blood results, operative reports, past medical history, investigation of alternative diagnoses, and management. Data entry was completed using Microsoft Excel. The hospital ethics committee approved this study. FindingsThe process for identification of cases for this series is detailed in Figure 1. This discussion will focus on the six cases admitted preoperatively with severe metabolic alkalosis and apneas and/or desaturations. Regarding the two other cases, one was admitted to PICU on day 2 for an acute pre-operative deterioration with massive hematemesis, and the second was admitted to PICU post-operatively for respiratory distress due to concurrent RSV bronchiolitis. This patient had a mixed picture of blood gases, with predominant respiratory acidosis. These cases will not be discussed further.Patient demographics are detailed in Table 1. All infants presented with persistent non-bilious vomiting after feeds, 5 of which had become projectile by presentation. At presentation, median chronological age 7.9 weeks (range: 4-12 weeks), corrected age 4.5 weeks (range: -0.5-12 weeks), and median weight 3.9kg (range: 2.7-4.2). Median duration of symptoms was 2.2 weeks (range: 0.5-6 weeks). Other symptoms included weight loss, reduced urine output (estimated by number of wet nappies), diarrhea, and constipation. On clinical assessment by emergency department physicians, all cases were documented as 'severely dehydrated' on admission.Two of the patients had po...

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Section: Discussionmentioning

confidence: 58%

Section: Resultsmentioning

confidence: 63%

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Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Jude

Ling²,

Ungern‐Sternberg

et al. 2016

JPNC

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“…Fifteen descriptive cases from eight publications were included for separate analysis 7,9,14,15,19‐22 . Most infants were male (80%).…”

Section: Resultsmentioning

confidence: 99%

Perioperative apnea in infants with hypertrophic pyloric stenosis: A systematic review

Bunder

Wijk

Woensel

et al. 2020

Pediatric Anesthesia

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Background Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis. Methods We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies. Results Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%‐16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS. Conclusions Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.

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“…3,[6][7][8] Both preoperative and postoperative respiratory problems are reported. [9][10][11][12] Therefore, biochemical abnormalities should be corrected prior to pyloromyotomy to prevent postoperative apnea or difficult extubation.…”

Section: Introductionmentioning

confidence: 99%

A Delphi Analysis to Reach Consensus on Preoperative Care in Infants with Hypertrophic Pyloric Stenosis

et al. 2020

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Introduction Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal condition that can lead to metabolic alkalosis and, if uncorrected, to respiratory complications. A standardized approach to correct metabolic derangements and dehydration may reduce time until pyloromyotomy while preventing potential respiratory complications. Such an evidence-based policy regarding preoperative care is absent. We aim to formulate a recommendation about preoperative care for infants with IHPS using the Delphi technique. Materials and Methods The RAND/UCLA appropriateness method was used to reach international consensus in a panel of pediatric surgeons, pediatric anesthetists, and pediatricians. Statements on type and frequency of blood sampling, required serum concentrations before pyloromyotomy and intravenous fluid therapy, were rated online using a 9-point Likert scale. Consensus was present if the panel rated the statement appropriate/obligatory (panel median: 7–9) or inappropriate/unnecessary (panel median: 1–3) without disagreement according to the interpercentile range adjusted for symmetry formula. Results Thirty-three and twenty-nine panel members completed the first and second round, respectively. Consensus was reached in 54/74 statements (73%). The panel recommended the following laboratory tests and corresponding cutoff values prior to pyloromyotomy: pH ≤7.45, base excess ≤3.5, bicarbonate <26 mmol/L, sodium ≥132 mmol/L, potassium ≥3.5 mmol/L, chloride ≥100 mmol/L, and glucose ≥4.0 mmol/L. Isotonic crystalloid with 5% dextrose and 10 to 20 mEq/L potassium should be used for fluid resuscitation. Conclusion Consensus is reached in an expert panel about assessment of metabolic derangements at admission, cutoff serum concentrations to be achieved prior to pyloromyotomy, and appropriate intravenous fluid regime for the correction of dehydration and metabolic derangements in infants with IHPS.

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Infantile hypertrophic pyloric stenosis (IHPS): it can take away your breath, alertness, wee and poo

Cited by 5 publications

References 3 publications

Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Respiratory Depression Caused By Infantile Hypertrophic Pyloric Stenosis

Perioperative apnea in infants with hypertrophic pyloric stenosis: A systematic review

A Delphi Analysis to Reach Consensus on Preoperative Care in Infants with Hypertrophic Pyloric Stenosis

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