A 8 year old girl is brought to the emergency room by EMS after having diarrhea and a history of fever for 5 days. She has an unremarkable past medical history. Immunizations are up to date.  Family history reveals that family members are well other than 2 siblings who have had diarrhea. 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 and no murmurs. Eyes are sunken, mucous membranes are dry, pulses are palpable, capillary refill is 4 seconds centrally. The abdominal examination reveals diffuse but non-peritonitic tenderness.