› NPO and aspiration reduction
› NPO status
› Strict no oral feeds until surgical plan clarified
› Dextrose containing IV fluids to prevent hypoglycemia
› Gastric decompression indications
› Persistent vomiting
› Significant distension
› Nasogastric tube low intermittent suction
› Large volume removal can improve ventilation and comfort
› Isotonic bolus strategy
› 0.9% sodium chloride 20 mL/kg IV
› Repeat bolus for ongoing hypoperfusion
› Reassess perfusion after each bolus
› Dextrose bolus only if symptomatic hypoglycemia
› Dextrose 10% 2 mL/kg IV
› Recheck glucose in 15 minutes
Maintenance and deficit replacement
› Ongoing IV fluids
› 0.9% sodium chloride with dextrose 5% infusion
› Rate based on weight maintenance plus deficit correction plan
› Avoid hypotonic solutions during active resuscitation
› Potassium supplementation rules
› Add potassium chloride only after urine output established
› Typical starting concentration 20 mmol KCl per liter
› Potassium repletion targets
› Potassium at least 3.5 mmol/L before anesthesia
› Continuous ECG monitoring during significant replacement
Electrolyte correction goals
› Preoperative metabolic correction
› Chloride repletion primary driver
› Chloride at least 100 mmol/L goal
› 0.9% sodium chloride preferred chloride source
› Alkalosis correction
› Bicarbonate 30 mmol/L or less goal
› Ventilation strategy adjustments in severe alkalemia
› Sodium correction
› Avoid rapid sodium shifts
› Frequent electrolytes in severe dehydration
› Surgical pyloromyotomy
› Standard definitive treatment
› Timing after resuscitation and metabolic normalization
› Not a true surgical emergency when stabilized
› Antibiotic prophylaxis per local protocol
› Cefazolin single perioperative dose commonly used
› Alternative for severe beta lactam allergy per protocol
› Atropine therapy pathway
› Consider only with pediatric surgery guidance
› Poor surgical candidate or resource limited setting
› Slower symptom resolution than pyloromyotomy
› Atropine regimen varies by institution
› IV atropine initiation with transition to oral dosing in some protocols
› Continuous monitoring for anticholinergic adverse effects
› Treatment success monitoring
› Tolerance of feeds
› Ultrasound improvement trend
Postoperative care essentials
› Feeding after pyloromyotomy
› Early feeding protocols common
› Small frequent feeds advancement as tolerated
› Postop emesis possible and usually self limited
› Analgesia
› Acetaminophen weight based dosing
› Opioid sparing approach preferred
› Complication surveillance
› Persistent vomiting beyond expected window
› Incomplete pyloromyotomy consideration
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