Differential Diagnosis
The patient presents with a complex history of alcohol dependence, recent THC and meth use, and symptoms of chest pain, shortness of breath (SOB), extremity numbness, and diaphoresis. Considering these factors, the differential diagnosis can be organized into the following categories:
- Single Most Likely Diagnosis
- Alcohol Withdrawal Seizure or Delirium Tremens: Given the patient's recent history of alcohol dependence and withdrawal, it is possible that the patient is experiencing a seizure or delirium tremens, which could explain the chest pain, SOB, and extremity numbness.
- Other Likely Diagnoses
- Acute Coronary Syndrome (ACS): The patient's symptoms of chest pain and diaphoresis could indicate ACS, especially considering the patient's history of substance use, which increases the risk of cardiovascular disease.
- Pulmonary Embolism (PE): The patient's symptoms of SOB and chest pain could also suggest PE, which is a possible complication of immobility or hypercoagulability associated with substance use.
- Hypokalemic Cardiac Arrhythmia: The patient's history of hypokalemia and recent substance use could increase the risk of cardiac arrhythmias, which could explain the chest pain and SOB.
- Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although the patient's symptoms may not be typical for MI, it is essential to consider this diagnosis due to the high risk of mortality and morbidity associated with missed MI.
- Aortic Dissection: The patient's symptoms of chest pain and SOB could indicate aortic dissection, which is a life-threatening condition that requires prompt diagnosis and treatment.
- Stroke or Transient Ischemic Attack (TIA): The patient's symptoms of extremity numbness could suggest a stroke or TIA, which would require immediate evaluation and treatment.
- Rare Diagnoses
- Wernicke's Encephalopathy: Although rare, Wernicke's encephalopathy is a possible complication of alcohol dependence and withdrawal, which could explain the patient's symptoms of confusion, ataxia, and ophthalmoplegia (if present).
- Cocaine-Induced Cardiomyopathy: Although the patient denies recent cocaine use, it is essential to consider this diagnosis due to the potential for cardiomyopathy and arrhythmias associated with cocaine use.