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| __NOTOC__ | | __NOTOC__ |
| {{Pyloric stenosis}} | | {{Pyloric stenosis}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{MMJ}} |
| ==Overview== | | ==Overview== |
| Correcting the dehydration and hypochloremic alkalosis for pyloric stenosis is very important.
| | Decompression of [[stomach]] by suction via [[nasogastric tube]], initial correction of fluid and [[Electrolyte disturbance|electrolyte imbalance]], oral administration of [[atropine sulfate]], and oral feeding with 10 ml of 10% [[glucose]] are necessary in treatment of pyloric stenosis. |
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| ==Medical Therapy== | | ==Medical Therapy== |
| It is important to understand that the danger of pyloric stenosis comes from the [[dehydration]] and [[electrolyte disturbance]] rather than the underlying problem itself. Therefore, the baby must be initially stabilized by correcting the [[dehydration]] and hypochloremic alkalosis with IV fluids. This can usually be accomplished in about 24-48 hours.
| | Medical therapt for infantile pyloric stenosis consists of conservative management and include:<ref name="pmid15615476">{{cite journal| author=Sretenović A, Smoljanić Z, Korać G, Sindjeć S, Lukac M, Krstić Z| title=[Conservative treatment of hypertrophic pyloric stenosis in children]. | journal=Srp Arh Celok Lek | year= 2004 | volume= 132 Suppl 1 | issue= | pages= 93-6 | pmid=15615476 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15615476 }} </ref><ref name="pmid15923695">{{cite journal| author=Singh UK, Kumar R, Prasad R| title=Oral atropine sulfate for infantile hypertrophic pyloric stenosis. | journal=Indian Pediatr | year= 2005 | volume= 42 | issue= 5 | pages= 473-6 | pmid=15923695 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15923695 }} </ref><ref name="pmid3592973">{{cite journal| author=Golladay ES, Broadwater JR, Mollitt DL| title=Pyloric stenosis--a timed perspective. | journal=Arch Surg | year= 1987 | volume= 122 | issue= 7 | pages= 825-6 | pmid=3592973 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3592973 }} </ref> |
| | | * Decompression of [[stomach]] by suction via [[nasogastric tube]] |
| ====Contraindicated medications==== | | * Initial correction of fluid and [[Electrolyte disturbance|electrolyte imbalance]] |
| | | * Oral administration of [[Atropine|atropine sulfate]] |
| {{MedCondContrAbs | | * Oral feeding with 10 ml of 10% [[glucose]] |
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| |MedCond = Organic pyloric stenosis|Macamylamine}} | |
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| ==Medical Therapy==
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| *Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
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| *Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
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| *Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
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| *Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
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| ===Disease Name=== | |
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| * '''1 Stage 1 - Name of stage'''
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| ** 1.1 '''Specific Organ system involved 1'''
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| *** 1.1.1 '''Adult'''
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| **** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
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| **** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
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| **** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
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| **** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
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| **** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
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| **** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
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| *** 1.1.2 '''Pediatric'''
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| **** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
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| ***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
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| ***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
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| ***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
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| ***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
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| ****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
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| ***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
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| ***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
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| ***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
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| ** 1.2 '''Specific Organ system involved 2'''
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| *** 1.2.1 '''Adult'''
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| **** Preferred regimen (1): [[drug name]] 500 mg PO q8h
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| *** 1.2.2 '''Pediatric'''
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| **** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
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| * 2 '''Stage 2 - Name of stage'''
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| ** 2.1 '''Specific Organ system involved 1 '''
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| **: '''Note (1):'''
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| **: '''Note (2)''':
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| **: '''Note (3):'''
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| *** 2.1.1 '''Adult'''
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| **** Parenteral regimen
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| ***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
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| ***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
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| ***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
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| **** Oral regimen
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| ***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
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| ***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
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| ***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
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| ***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
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| ***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
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| ***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
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| *** 2.1.2 '''Pediatric'''
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| **** Parenteral regimen
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| ***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
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| ***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
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| ***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
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| **** Oral regimen
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| ***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
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| ***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
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| ***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
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| ***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
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| ***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
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| ** 2.2 '''Other Organ system involved 2'''
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| **: '''Note (1):'''
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| **: '''Note (2):'''
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| **: '''Note (3):'''
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| *** 2.2.1 '''Adult'''
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| **** Parenteral regimen
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| ***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
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| ***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
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| ***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
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| **** Oral regimen
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| ***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
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| ***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
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| ***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
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| ***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
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| ***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
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| ***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
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| *** 2.2.2 '''Pediatric'''
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| **** Parenteral regimen
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| ***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
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| ***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
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| ***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) | |
| **** Oral regimen
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| ***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
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| ***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose) | |
| ***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose) | |
| ***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day) | |
| ***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
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| ==References== | | ==References== |
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| {{WS}} | | {{WS}} |
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| | [[Category:Surgery]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Surgery]] | | [[Category:Disease]] |
| | [[Category:Pediatrics]] |
| | [[Category:Up-To-Date]] |