A baby is admitted to the hospital with a history of projectile vomiting after e

Question

A baby is admitted to the hospital with a history of projectile vomiting after each feeding. After examination it is found that the spinchter controlling the food passage from the stomach to the duodenum is thickened and does not open readily. A. Describe the abnormal serum chemistry values for ph and for bicarbonate ions B. And I respiratory system is compensating what levels of pco2 should be observed A baby is admitted to the hospital with a history of projectile vomiting after each feeding. After examination it is found that the spinchter controlling the food passage from the stomach to the duodenum is thickened and does not open readily. A. Describe the abnormal serum chemistry values for ph and for bicarbonate ions B. And I respiratory system is compensating what levels of pco2 should be observed A. Describe the abnormal serum chemistry values for ph and for bicarbonate ions B. And I respiratory system is compensating what levels of pco2 should be observed

Explanation / Answer

A) This is most probably the case of congenital hypertrophic pyloric stenosis (CHPS) . Here the serum electrolyte abnormality seen is hypochloremic hypokalemic metabolic alkalosis with paradoxical aciduria ( the vomiting of HCl causes hypochloraemic alkalosis. Initially the sodium and potassium may be relatively normal but as the dehydration progresses more metabolic abnormalities arises , partly due to renal dysfunction. Initially the urine has low chloride and high bicarbonate content, this bicarbonate is excreted along with sodium and so with time patients become progressively hyponatramic and dehydrated. Because of dehydration a phase of sodium retention follows and potassium and hydrogen is excreted in preference thus resulting in paradoxical aciduria) Now the simple key concept is due to prolonged vomiting there is loss of gastric juice with H+ ions leading to metabolic alkalosis.   thus the pH will increase and level of bicarbonate ion Increases ( primary change) B) compensatory respiratory mechanism- hypoventilation to conserve co2 , thus pCO2 increases

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