A 4 years old boy presents to the emergency department with diffuse abdominal pain that is worse with bowel movements. The child has no urinary symptoms. The pain started 35 hours ago. He has no history of fever and has had no vomiting with infrequent hard stools with occasional watery stools. Is stooling twice a week. Has no known sick contacts.

Past Medical History:

Past medical history is is significant for a history of poor fluid intake. Has had mild, episodic abdominal discomfort for several months. Immunizations are up to date. The child is on the 50th percentile for weight and growing well.

Family / Social History:

Family history is unremarkable. Social history is negative. 

Physical Exam:

On physical exam the patient appears well. Abdominal exam reveals stool on digital rectal exam.

Labs:

Bloodwork:

WBC: 18.1x109/L

Platelets: 457x109/L

Hemoglobin: 141 g/L

MCV: 82 fL

C-reactive Protein: 4 mg/L

Imaging:

Abdominal Xray: Fecal loading