A 2-year-old girl with no significant medical history presents to the pediatric emergency department (ED) with a 1-month history of decreased frequency of bowel movements and hard stools. She had intermittent abdominal pain during this time as well.

She was brought to her pediatrician as well as multiple EDs, where radiographs were obtained and showed “constipation,” according to her parents. Her parents had been consistently giving the patient a bowel regimen, but she continued to get worse. In the past week she had intermittent nausea and nonbloody, nonbilious vomiting. She also complained of 1 day of dysuria and decreased urine output.

In the ED her vital signs are as follows: temperature, 99.3°F (37.4°C); heart rate, 130 beats/min; respiratory rate, 26 breaths/min; blood pressure, 114/79 mm Hg; and oxygen saturation, 98% on room air. She is tired appearing, with dry mucous membranes. Her abdomen is soft, mildly tender with palpation in...

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