A 14-year-old boy presents with nausea, vomiting (3–4 times per day), and abdominal pain lasting 7 days. The abdominal pain is sharp and rated 6 of 10 without radiation. The patient and his mother deny fever and weight loss. He had a bowel movement 4 days before presentation and has had decreased urination for the past 3 days. His medical history includes kidney disease, and his surgical history is unremarkable. He plays basketball at school and has no history of recent travel or excessive exercise. His Patient Health Questionnaire-9 score reveals no evidence of depression, and his psychiatric history rules out an eating disorder.

His temperature is 96.1°F (35.6°C), heart rate is 92 beats/min, respiratory rate is 20 breaths/min, blood pressure is 134/90 mm Hg, and oxygen saturation is 98% on room air. His weight is 117.7 lb (53.4 kg), height is 70.0 in (177.8 cm), and BMI is 16.8,...

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