A Patient with a History of Traumatic Brain Injury and Fever

A 12-year-old female with a history of traumatic brain injury, spastic cerebral palsy, ventriculoperitoneal shunt, gastrostomy tube (G-tube) dependence, and ventilator dependence presents to the emergency department with emesis, feeding intolerance, fatigue, and fever for 4 days. On physical exam, she is tachycardic and febrile, with a normal cardiac, pulmonary, and abdominal exam. She is on stable ventilator settings, and her G-tube is functioning well. Her labs are notable for hypoglycemia and hyponatremia. Normal saline boluses and antibiotics are provided, yet her vital signs remain concerning including persistent fever, tachycardia, and hypotension.