Case Presentation: A five year old male presents to the emergency department with abdominal pain and emesis. Labs were significant for hyponatremia, elevated alkaline phosphatase, mild hyperproteinemia, and leukocytosis with neutrophilia. Urinalysis showed ketones present. A plain film of the kidneys, ureter, and bladder showed distension of the transverse colon and stool in the rectum. [...]