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A 3 year old girl is brought to the emergency room by EMS after having a history of fever and having emesis and diarrhea for the past 3 days. She has an unremarkable past medical history. Immunizations are up to date for age.  Family history reveals that all family members are healthy. Social history is negative. Upon examination, the patient appears unwell. The patient is responsive but lethargic. The neurological,respiratory, and skin exams appears normal. The cardiovascular examination shows normal heart sounds and no murmurs. Eyes are sunken, mucous membranes are dry, pulses are palpable, capillary refill is 4 seconds centrally. The abdominal examination reveals vague and diffuse pain. 

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