A 10-year-old boy experienced the abrupt onset of fever (temperature up to 104°F [40°C]) 48 hours ago, followed by vomiting (four to five times daily) and diarrhea (three to four times a day). The stools have been loose, watery, and mixed with mucus but not blood. After 24 hours, the temperature dropped to normal, but the vomiting and diarrhea persisted.

Despite his weary appearance, the child is alert and communicative. His temperature is 98.6°F (37°C), respirations are 25 breaths/min, pulse is 108 beats/min, and blood pressure is 108/78 mm Hg. His oral mucous membranes are mildly dry, and he is estimated to be 3% to 4% dehydrated. He has clear breath sounds; cardiac auscultation reveals only tachycardia. The bowel sounds are markedly increased and the abdomen mildly tender on palpation but without any localizing signs. The liver and spleen are not palpable. The rest of the examination yields normal findings....

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