A 3 years old girl presents to the emergency department with diffuse abdominal pain. The child has no urinary symptoms. The pain started 61 hours ago. She has no history of fever and has had no vomiting with hard stools with frequent soiling of underwear. Is stooling twice a week. Has no known sick contacts.

Past Medical History:

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

Family / Social History:

Family history is unremarkable. Social history is unremarkable. 

Physical Exam:

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

Labs:

Bloodwork:

WBC: 11.5x109/L

Platelets: 338x109/L

Hemoglobin: 146 g/L

MCV: 88 fL

C-reactive Protein: 9 mg/L

Imaging:

Abdominal Xray: Fecal loading