<prompt> The metabolic derangement in congenital pyloric stenosis isHypochloremic alkalosisHyperchloremic alkalosisHyperchloremic acidosisHypochloremic acidosis  <response>: Clinical manifestations of congenital hypertrophic pyloric stenosis Pyloric stenosis is usually not present at birth.Nonbullous vomiting is the initial symptoms of pyloric stenosis.The vomiting usually starts after 3 weeks of age, but symptoms may develop as early as the 1st week of life and as late as the 5 months of life.Emesis may follow each feeding, or it may be intermittent.After vomiting, the infant is hungry and wants to feed again.Due to vomiting, there is a progressive loss of Fluid, Hydrogen ion, ChloridesThis results in hypochloremic metabolic alkalosis.Serum potassium levels are usually maintained, but there may be a total body potassium deficit.Jaundice unconjugated bilirubin is associated with a decreased level of glucuronyl transferase in 5 of patients. 