Worsening Emesis and Oral Intolerance in a Nonverbal 17-year-old Boy

A 17-year-old nonverbal boy with Angelman syndrome, spastic cerebral palsy, developmental delay, and epilepsy presents with 2 days of several episodes of nonbloody, nonbilious emesis. His epilepsy is well controlled with levetiracetam and clonazepam. His surgical history includes posterior capsular release with Achilles tendon, flexor hallicus longus, and posterior tibial tendon lengthening performed 4 years ago, and a T4-L4 posterior spinal fusion performed 7 years ago; of note, he has no history of abdominal surgery. He presents with decreased urine output but no change in bowel movements. He has a history of chronic constipation and normally passes hard stools every 2 to 3 days, although he is not on a regular bowel regimen. He typically eats a normal diet by mouth, but he has not been able to tolerate anything by mouth since the onset of this intermittent emesis. He has no known sick contacts, aside from his mother having...