He had two additional episodes of forceful vomiting after which he became quite somnolent and he subsequently fell asleep. When mother attempted to arouse him an hour later, he would not awaken. She immediately brought him to the Emergency Room. On physical exam, he is an quite lethargic and somewhat fussy but very well-grown and in no distress. He has brisk and symmetrical distal pulses.
Liver enzymes are also normal.
A lumbar punture is performed. An ECG is also performed is thought to be normal for age. While he is still in the Emergency Room, the infant passes a large watery stool which is grossly bloody. Microscopic examination of the stool does not demonstrate any leukocytes. On rectal examination, he has largely empty vault of normal size.