Pyloric stenosis Quiz: Ace Your Exams

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A 5-week-old boy presents to the emergency department (ED) with 3 days of vomiting. His parent reports that he was born at term via vaginal delivery and was discharged within 24 hours. Since then, he has been feeding, voiding, and stooling normally. Over the last few days, however, he has developed projectile, non-bilious emesis after each feeding. His last wet diaper was approximately 12 hours ago. In the ED, his temperature is 36.2 °C (97.2 ºF), pulse is 172/min, respirations are 52/min, blood pressure is 62/25 mmHg, and SpO2 is 98%. On physical examination, the patient has a sunken anterior fontanelle, dry mucous membranes, and capillary refill in 6 seconds. His abdomen is non-distended, and on palpation, a small round mass in the right upper quadrant is felt. Bloodwork and intravenous (IV) access is obtained, and the results are shown below. What is the best next step in management?  

Laboratory value
Result
Serum chemistry

Sodium
137 mEq/L
Potassium
3.1 mEq/L
Chloride
85 mEq/L
CO2
34 mEq/L
Creatinine
0.31 mg/dL
BUN
10 mg/dL
Complete blood count

Leukocyte Count
8.2 g/dL
Hemoglobin
15.4 g/dL
Hematocrit
46 %  
Platelet Count
225,000/mm3
Venous Blood Gas

pH
7.52
PCO2
51 mmHg
PO2
33 mmHg
HCO3
40.8 mmol/L

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