Question:
What is the metabolic finding seen in a baby with CHPS (Congenital Hypertrophic Pyloric Stenosis)?
What is the metabolic finding seen in a baby with CHPS (Congenital Hypertrophic Pyloric Stenosis)?
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Think about what is lost when a baby repeatedly vomits gastric acid.
Updated On: Jun 23, 2026
- Hyperchloremic hypernatremic metabolic alkalosis
- Hypochloremic hypernatremic metabolic acidosis
- Hypochloremic hyponatremic metabolic alkalosis
- Hyperchloremic hyponatremic metabolic alkalosis
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The Correct Option is C
Solution and Explanation
Step 1: Understand CHPS pathophysiology.
Congenital Hypertrophic Pyloric Stenosis (CHPS) is the most common surgical cause of vomiting in infants, typically presenting at 4 weeks of age. The hypertrophied pyloric muscle causes gastric outlet obstruction leading to projectile, non-bilious vomiting.
Step 2: Analyze metabolic consequences of repeated vomiting.
Gastric contents are rich in HCl. Repeated vomiting causes:
- Loss of H+ ions leads to metabolic alkalosis.
- Loss of Cl- ions leads to hypochloremia.
- Volume depletion activates the renin-angiotensin-aldosterone axis; aldosterone promotes Na+ reabsorption in exchange for K+ and H+, resulting in hyponatremia and hypokalemia.
Step 3: Classic metabolic picture in CHPS.
The characteristic finding is hypochloremic, hyponatremic metabolic alkalosis with hypokalemia. A palpable olive-shaped mass in the right upper quadrant is pathognomonic on examination.
Step 4: Correct option.
Option C (Hypochloremic hyponatremic metabolic alkalosis) matches exactly.
Congenital Hypertrophic Pyloric Stenosis (CHPS) is the most common surgical cause of vomiting in infants, typically presenting at 4 weeks of age. The hypertrophied pyloric muscle causes gastric outlet obstruction leading to projectile, non-bilious vomiting.
Step 2: Analyze metabolic consequences of repeated vomiting.
Gastric contents are rich in HCl. Repeated vomiting causes:
- Loss of H+ ions leads to metabolic alkalosis.
- Loss of Cl- ions leads to hypochloremia.
- Volume depletion activates the renin-angiotensin-aldosterone axis; aldosterone promotes Na+ reabsorption in exchange for K+ and H+, resulting in hyponatremia and hypokalemia.
Step 3: Classic metabolic picture in CHPS.
The characteristic finding is hypochloremic, hyponatremic metabolic alkalosis with hypokalemia. A palpable olive-shaped mass in the right upper quadrant is pathognomonic on examination.
Step 4: Correct option.
Option C (Hypochloremic hyponatremic metabolic alkalosis) matches exactly.
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