A 4-Week-Old, Full-Term Boy Is Brought to the Office Due

A 4-week-old, full-term boy is brought to the office due to vomiting.  Since birth, he has had small spit-ups with feeding.  However, for the past few days he has had forceful emesis after every feed that is worsening.  The emesis consists of formula and is neither bilious nor bloody.  Despite this, the patient has an excellent appetite and "always seems hungry."  He passes one small stool every other day, and his last bowel movement was yesterday.  Weight today is down 0.5 kg (1.1 lb) from a well-child visit 2 weeks ago.  On examination, the patient is awake and alert.  His anterior fontanelle is sunken and he has decreased skin turgor.  Capillary refill is 3 seconds.  The abdomen is soft, nontender, and nondistended.  The scrotum has no erythema, and the testes are descended.  Which of the following is the best next step in management of this patient?

A) Abdominal radiograph
B) Abdominal ultrasound
C) CT scan of the head
D) Serum 17-hydroxyprogestorone level
E) Stool guaiac test
F) Trial of reflux precautions

Correct Answer:

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