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Ralf-Bodo Tröbs

• Background: The aim of this study was to elucidate the preoperative clinical and biochemical profile of infants with IHPS to optimize infusion therapy. Patients and Method: We retrospectively analyzed data from 56 infants who were operated for IHPS. Our study includes growth and laboratory data prior to the initiation of therapy. Results: Median duration of propulsive vomiting was 4 d; the median age was 37 d (18-108), and the median body weight was 3840 g (2760-5900). Metabolic alkalosis (MAlk) with a pH of 7.45 \(\pm\) 0.06 and an stHCO\(^{-}\)\(_{3}\) of 28.7 \(\pm\) 4.5 mmol/l was found. In a subgroup of the infants, negative base excess (BE) was observed. The sodium concentration was normal or reduced (mean/median of 137 mmol/l). There was a strong negative correlation between stHCO\(^{-}\)\(_{3}\) and K\(^{+}\). The carbon dioxide partial pressure tended to increase (5.72 \(\pm\) 0.84 kPa). Calculations of osmolality revealed a normal osmolarity. Hypoglycemia did not occur. The creatinine clearance according to the Schwartz formula remained at a normal level (85.3 \(\pm\) 24.3 ml/min/1.73 m\(^{2}\)). Discussion: The presented case series is characterized by a short duration of preoperative vomiting. MAlk can be classified as a chloride deficiency syndrome. It is accompanied by normo- or hyponatremic dehydration with normal osmolality. Partial respiratory compensation occurred. A normal creatinine clearance indicated good glomerular renal function. Conclusion: The presented study supports the use of an isotonic infusion fluid with a low glucose concentration for preoperative infusion therapy.