Differential Diagnosis for DKA with Vomiting, Ketonuria, and Finger Stick 94
- Single most likely diagnosis:
- Diabetic Ketoacidosis (DKA) with possible stress-induced hyperglycemia or a mixed presentation of DKA and another condition causing vomiting, but the normal finger stick glucose level may suggest an atypical presentation or another diagnosis altogether.
- Other Likely diagnoses:
- Gastroenteritis or other gastrointestinal infection causing vomiting and dehydration, which could lead to ketonuria due to the body's stress response and possible fasting state.
- Urinary tract infection (UTI) or other infections that could cause vomiting and lead to ketonuria, especially if the patient has diabetes or is prone to glucose imbalances.
- Alcoholic ketoacidosis, which could present similarly to DKA but often with a lower glucose level.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Uremic gastroenteritis: In patients with renal failure, uremia can cause severe vomiting and dehydration, leading to a clinical picture that might resemble DKA.
- Salicylate or other toxic ingestions: Certain poisonings can cause vomiting, metabolic acidosis, and altered mental status, mimicking DKA.
- Severe sepsis or septic shock: While less common, severe infections can lead to a presentation that includes vomiting, altered mental status, and metabolic disturbances.
- Rare diagnoses:
- Fatty acid oxidation disorders: Rare genetic disorders that can cause episodes of severe illness, including vomiting and metabolic disturbances, which might be mistaken for DKA.
- Ketotic hypoglycemia: A condition more common in children, where hypoglycemia is accompanied by ketosis, which could potentially be confused with DKA in its presentation.