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Jonathan is a 21 month old boy referred to the pediatric day unit by his GP. He was seen in the surgery the previous day with diarrhoea and vomiting and seemed to have tummy ache. The vomit contained a small amount of fresh blood, but as he was otherwise well and cardiovascular stable, admission had been deferred because his mother is 36 weeks into her fourth pregnancy. Instead, later that day, the GP rang to check how he was and was reassured to hear that he seemed to have recovered and was tolerating drinks and some food. however, he seems lethargic and finger price blood glucose test performed by his GP was only 3.1mmol/l.Jonathan is the youngest of three children, the older two being6 and 3 years. his father is Navy and is currently at sea.

INVESTIGATIONS

Respiratory rate 26breaths/mim

Pulse rate 180beats/min

capillary refill time 5seconds

Prothrombin time 19sec

prtial thrombipastin time 32sec

Hb 12.3g/dl

WBCs 8.4*10^9/l

a) what pathological process are evident from his clinical findings

b) what is the most likely unifying cause

c) how is this condition managed.