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A 17-year-old woman presents to the emergency department with complaints of fever, anorexia, abdominal pain, and nausea for the past two days. She has also had five episodes of diarrhea in the past day. She mentions that she developed a urinary tract infection three weeks ago that resolved by a course of antibiotics. She has no medical problems and does not take any medications. The patient mentions that she recently went on a three-day adventure trip near the river with a few friends. She returned two days ago. She does not use tobacco but drinks alcohol on weekends. Vitals show a blood pressure of 95/65 mm Hg, a pulse of 110/min, a respiratory rate of 18/min, and a temperature of 38.1 C (101 F). Physical examination reveals an ill-looking woman with dry mucus membranes. Which of the following most likely contributed to the patient's condition?
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