6-week-old boy is brought to the physician with persistent, worsening vomtting over the past 2 weeks. The emesis occurs with
every feed, is nonbilious, and is projectile in nature. The emesis has persisted even though his mother has tried small, frequent feeds
and holding the infant upright after feeds. On physical examination, peristaltic waves are seen over the upper abdomen, and an oliveshaped
mass is palpated in the right upper quadrant. Laboratory results are as follows:
Serum chemistry
Sodium 133 mEq/L
Potassium 2.8 mEq/L
Chloride 90 mEq/L
Bicarbonate 36 mEq/L
Blood urea nitrogen 18 mg/dl
Creatinine 0 . 6 mg/dl
Glucose 100 mg/dl
Which of the foll owing is the most appropriate next step in management of this patient?
- Q A. Elective surgery later in childhood
- Q B . Immediate surgery
- Q C. Intravenous hydration and potassium replacement
- Q D . Oral metoclopramide
- Q E. Switch to a hydrolyzed formula
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