139
98
20
39.0
98/49

A 4 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 was previously well. Immunizations are incomplete.  Family history reveals that all family members are healthy. Social history reveals that the patient's parents are separated. 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