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A 4 year old boy is brought to the emergency room by EMS after having diarrhea for 5 days and feeling lethargic for the past 12 hours. He was previously well. Immunizations are up to date for age.  Family history reveals that the patient has a sister with asthma. Social history is unremarkable. Upon examination, the patient appears dehydrated. The patient is responsive but lethargic. The neurological,respiratory, and skin exams appears normal. The cardiovascular examination shows normal heart sounds. Mucous membranes are dry, pulses are palpable but weak, capillary refill is 5 seconds centrally and peripherally. The abdominal examination reveals diffuse but non-peritonitic tenderness. 

The most likely diagnosis for this child is:

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Authors

Dr. Theresa Wu

theresa.wu@ahs.ca

Dr. Susan Bannister

Susan.Bannister@ahs.ca

Reviewers

Dr. Marc Zucker

Zucker@cheo.on.ca

Dr. Gabriele Weiler

gweiler@cheo.on.ca