Your primary assessment of the infant reveals the following: s.B is alert and fussy and consoles with a

Question

bottle of Pedialyte (per physician orders). His anterior fontanel is slightly depressed and posterior fontanel
cannot be palpated.

you auscultate regular breath sounds at a rate of 18 breaths/min. No adventitious
sounds. Pulse oximetry is 98% on room air. Heart rate is 140 beats/min with regular rate and rhythm.
Brachial and pedal pulses are +3 and equal. Abdomen is round and nontender to palpation. Positive
bowel sounds. diaper is dry. s.B. moves all extremities and there are no rashes noted. Rectal temperature
is 98.9 ° F (37.2 ° C). There is a quarter-sized flat red area on occiput that "has been there since he was born"
according to the mother. slight "tenting" noted.
you transport s.B. to radiology and he vomits a large amount of clear fluid. Patient returns to the
room in his mother's arms, awake and alert. The mother appears anxious and states, "I don't know what's
wrong with my baby! Why can't you people tell me anything?"

The emergency physician orders a complete blood count, complete metabolic profile,
urinalysis, blood pH, and x-rays. The physician suspects dehydration and metabolic alkalosis
secondary to hypertrophic pyloric stenosis. Which of these laboratory findings would you
expect with metabolic alkalosis?
a. Na: 128 mEq/L, K: 2.6 mEq/L, Cl: 90 mEq/L, HCO3: 28 mEq/L
b. Na: 130 mEq/L, K: 5.7 mEq/L, Cl: 94 mEq/L, HCO3: 22 mEq/L
c. Na: 130 mEq/L, K: 3.9 mEq/L, Cl: 98 mEq/L, HCO3: 17 mEq/L
d. Na: 148 mEq/L K: 4.1 mEq/L, Cl: 108 mEq/L, HCO3: 13 mEq/L

Answer 1

a
A common finding with hypertrophic pyloric stenosis is hypochloremic, hypokalemic metabolic
alkalosis, which is reflected in the low Na, K, and Cl levels and elevated bicarbonate.