Review Question - QID 210506

A 9-year-old African American boy is brought to the emergency room by his mother after he started experiencing nausea, vomiting, and abdominal pain. He developed these symptoms 2 days prior to presentation, and they have gotten progressively worse since then. His vomitus is non-bloody and non-bilious. His mother also reports that he had a minor upper respiratory tract infection 1 week ago that resolved after 2 days. He is otherwise healthy and takes no medications. He plays recreational soccer. His family history is unremarkable. His temperature is 98.8°F (37.1°C), blood pressure is 101/62 mmHg, pulse is 110/min, and respirations are 26/min. On examination, he appears lethargic but is alert and oriented to person, place, and time. Capillary refill is delayed, and mucous membranes are dry. He is mildly tender to palpation diffusely throughout his abdomen. Laboratory analysis is shown below:

Serum:
Na+: 143 mEq/L
Cl-: 103 mEq/L
K+: 5.3 mEq/L
HCO3-: 15 mEq/L
BUN: 19 mg/dL
Glucose: 426 mg/dL
Creatinine: 0.9 mg/dL

Which of the following laboratory changes in Figure A would you expect to see in this patient?