Infectious gastroenteritis (acute) (pediatrics) Quiz: Ace Your Exams

A 2-year-old boy is brought to the clinic in winter with a 2-day history of watery diarrhea and intermittent non-bilious vomiting. The caregiver reports that fever and vomiting began suddenly 1 day before the onset of diarrhea. The boy has had six episodes of diarrhea and three episodes of vomiting in the past 24 hours. He has been drinking small amounts of water but is less active. There has been no recent travel or known exposure to contaminated food or water. Several children at daycare have had similar symptoms. Temperature is 38°C (100.4°F), blood pressure is 90/55 mmHg, heart rate is 130 beats per minute, respiratory rate is 24 breaths per minute, and oxygen saturation is 98% on room air. On examination, the child is alert but appears tired. No rashes are noted. Cardiopulmonary and abdominal examinations are unremarkable. Stool PCR testing is positive for a double-stranded RNA virus. Which of the following elements of the history or physical examination is most likely to be present in this patient?