Differential Diagnosis
The patient's symptoms of diaphoresis, nausea, and feeling unsteady can be attributed to various causes. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Hypoglycemia: The patient has a history of diabetes and did not eat breakfast before the episode. The symptoms of diaphoresis and nausea, which were relieved by eating, suggest hypoglycemia. The fact that he didn't take his morning medications, which may include diabetes medications, further supports this diagnosis.
- Other Likely diagnoses
- Dehydration: The patient was preaching at church and may have been dehydrated, especially since he didn't eat breakfast. Dehydration can cause symptoms like dizziness, nausea, and diaphoresis.
- Orthostatic hypotension: The patient's history of hypertension, CKD, and OSA, as well as his recent restart of gabapentin, may contribute to orthostatic hypotension. The symptoms of feeling unsteady and "wobbly in the knees" support this diagnosis.
- Vasovagal syncope: The patient's episode of diaphoresis and nausea, which occurred while he was preaching, may be related to a vasovagal response. The fact that he felt better after resting and eating also supports this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction: Although the patient denies chest pain, myocardial infarction can present atypically, especially in older adults. The patient's history of hypertension and CKD increases his cardiovascular risk.
- Arrhythmia (e.g., SVT): The patient has a history of SVT, and his symptoms of diaphoresis and nausea could be related to an arrhythmic episode.
- Severe hypokalemia or hyperkalemia: The patient's history of CKD and hypertension increases his risk of electrolyte imbalances, which can cause symptoms like muscle weakness, nausea, and diaphoresis.
- Rare diagnoses
- Pheochromocytoma: This rare tumor can cause episodes of diaphoresis, nausea, and hypertension. Although it's unlikely, it's essential to consider it in the differential diagnosis.
- Neurological disorders (e.g., seizure, transient ischemic attack): The patient's history of neuropathic pain and recent restart of gabapentin may contribute to neurological symptoms. Although rare, these conditions can present with non-specific symptoms like diaphoresis and nausea.