Differential diagnosis includes VPS malfunction or infection producing increased ICP. Other dagnerous causes of acute vomiting are also on the differential including pyloric stenosis, intussusception, appendicitis or SBO although in this patient they are unlikely. Considered viral syndromes (URI, gastritis, gastroenteritis) as well as other non-emergent causes of vomiting.

Given this patient’s shunt, will evaluate with shunt series // CT // limited MRI, discuss with neurosurgery for possible tap, supportive care, reassess.