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A mother calls on the emergency line about her 3 year old child as her child has been vomiting for the past 24 hours. She feels he is lethargic and thinks he has passed less urine today compared to normal. He has had 6 loose bowel movements today. There is no history of fever or rectal bleeding. An urgent clinic appointment is arranged today for examination. Which one of the following combination of signs would concern you the most?

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