History Newborn female brought to the ER for vomiting Born full term, 37 weeks AOG, 3200 g 30-year mother Last ultrasound: polyhydramnios, dilated bowel loops Breastfed initially, subsequently developed vomiting of previously ingested milk  bilious vomiting after a few hours

PE Good cry and activity HR: 144 beats/min RR: 26 breaths/min Afebrile Clear breath sounds, distinct heart sounds Abdomen distended, hyperactive bowel sounds Rectal examination: collapsed vault

Laboratory Examinations: CBC ResultNormal RangeRemarks Hb137 g/dL g/dL↑↑ Hct41 % vol44 – 64 % volNormal* WBC21,000 /mm 3 9,000 – 30,000 /mm 3 Normal Platelets102,000 /mm 3 150,000 – 450,000 /mm 3 ↓

Laboratory Examinations: Blood Chemistry ResultNormal RangeRemarks Na138 mmol/L136 – 145 mmol/LNormal K4.8 mmol/L3.5 – 5.0 mmol/LNormal Cl108 mmol/L98 – 106 mmol/LNormal* Ca2.14 umol/L2.2 – 2.6Normal* Albumin32 g/L35 – 55 g /LNormal*

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