THE CASE
A 6-year-old, previously healthy girl presents from an outside hospital for poor oral intake and new onset tremors. One week ago, symptoms began with fever, fatigue, and weakness that lasted for 4 days. She then complained of abdominal pain and developed 3 episodes of nonbilious, nonbloody emesis, which have since resolved. Her mother reports that the outside hospital course was pertinent for intravenous (IV) fluid rehydration along with an abdominal x-ray that demonstrated an ileus, for which the child received total parenteral nutrition for 2 days. The family is coming to you now because the child continues to be unable to take oral nutrition and has developed new troublesome symptoms.