Differential Diagnosis for the 17-year-old boy's condition
- Single most likely diagnosis
- E) Toluene: The patient's presentation of confusion, hallucinations, euphoric mood, and ataxic gait, combined with the finding of eczema around the mouth (suggestive of glue sniffing or inhalant abuse), makes toluene intoxication the most likely cause. Toluene is a solvent found in glues, paints, and other household products, and its inhalation can lead to symptoms similar to those described.
- Other Likely diagnoses
- D) PCP (Phencyclidine): PCP intoxication can cause hallucinations, confusion, and altered mental status, which align with the patient's symptoms. However, PCP use is less likely to be associated with eczema around the mouth.
- B) Cocaine: Cocaine intoxication can lead to euphoria, hallucinations, and altered mental status, but it is less likely given the absence of other typical cocaine-related symptoms such as hypertension, tachycardia, or dilated pupils.
- Do Not Miss diagnoses
- Hypokalemia: Although the patient's serum potassium concentration is low (2.8 mEq/L), which can cause muscle weakness, it is unlikely to be the primary cause of his hallucinations and altered mental status. However, hypokalemia can have serious cardiac complications, making it a "do not miss" diagnosis.
- Intracranial hemorrhage or other CNS emergencies: Although the CT scan of the head shows no abnormalities, it is essential to consider other CNS emergencies, such as intracranial hemorrhage or infection, which could present with similar symptoms.
- Rare diagnoses
- A) Alcohol: Alcohol intoxication is less likely given the patient's symptoms and the absence of a typical alcohol-related history or physical examination findings.
- C) Oxycodone: Oxycodone intoxication can cause altered mental status, but it is less likely to cause hallucinations or the specific combination of symptoms presented by the patient.