Clinical History.—This was the first hospital admission for this 26-month-old boy. He had been well until ten days prior to admission when he developed fever, vomited, and had symptoms of an upper respiratory tract infection. He did not have a sore throat or skin rash. He was treated with antibiotics intramuscularly and orally. Four days prior to admission, he had wheezing, tachypnea, and orthopnea. The night before admission, he complained of increased thirst, irritability, decreased urinary output, and discomfort unless held in the knee-chest position. The remainder of the history was noncontributory.
Physical Examination.—He was a well-developed, well-nourished boy who was slightly pale and was irritable. His temperature was normal. The pulse rate was 140 beats per minute, and the respirations were 40 breaths per minute. The blood pressure was 126/90 mm Hg. Results from examination of the head, eyes, ears, nose, and mouth were normal. The chest