A 2-year-old girl, previously healthy and an established patient, arrives at your office with a complaint of vomiting and fever. History of present illness includes a 24-hour period of fever and vomiting followed by onset of irritability. She has been refusing all food and liquids today. The parents tried acetaminophen for her fever, but she refused. She last voided 12 hours prior to the visit. On review of systems, she had symptoms of an upper respiratory infection 3 days prior, but the remainder of a complete system review was negative. The patient is not on any medications and has no known allergies. She attends child care, where a few other children have been out this week.

The physical examination includes vital signs, eyes, ears, nose, throat, neck, lungs, heart, abdomen, skin, and mental status. She has lost 2 pounds from a recent visit and is tachycardic and inactive with dry...

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