A previously healthy 17-year-old girl is transferred to our institution from a community hospital emergency department due to laboratory findings of anemia, thrombocytopenia, and acute kidney injury. She initially presented with syncope that occurred at home after standing up from a seated position. The patient also reports 2 weeks of intermittent frontal headache and 4 episodes of nonbloody, nonbilious vomiting in the past 48 hours. She attributes her vomiting to eating improperly refrigerated crabs and denies recent fever, diarrhea, bloody stool, weight loss, dyspnea, or chest pain. There is no history of recent travel, and there are no known sick contacts. Her only daily medication is an oral contraceptive pill. Her last menstrual period was 1 week ago and lasted approximately 1 week. She received ondansetron and 2,000 mL of crystalloid fluid before her transfer.

Physical examination reveals an adolescent girl in no acute distress. Initial vital signs include a...

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