A 4-month-old female who presented with a chief complaint of fever, vomiting, and loose stools. She has had tactile fever for 3 days, and had 5-6 emesis episodes on the first day of illness. Stools were liquid on the 1st and 2nd days of illness. She was seen at an Emergency Dept. 2 days ago, where the impression was gastroenteritis. No labs or x-rays were done in the emergency dept. She is referred again because of persistent fever. Vomiting and diarrhea have resolved, but she is breast-feeding less well than usual.
Her mother notes that her urine seems "strong" and that she is not as playful as usual. She has had no known ill contacts. She has no cough, URI symptoms, or rash. Past history is unremarkable and she is on no medications. Physical Exam: VS T 38.9, P164, R40, Wt. 5.3kg (15%ile, and 150gm below her pre-illness weight). Patient is alert, smiling, active, not toxic,…
