Differential Diagnosis for Patient with Persistent Nausea and Vomiting
The patient's symptoms and laboratory results suggest a complex clinical picture. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Cannabinoid Hyperemesis Syndrome (CHS): This condition is characterized by recurrent episodes of severe vomiting, often accompanied by abdominal pain, and is associated with long-term marijuana use. The patient's history of marijuana use and symptoms of persistent nausea and vomiting for 6 days support this diagnosis.
Other Likely Diagnoses
- Acute Pancreatitis: Elevated liver enzymes (ALT-SGPT 120, AST-SGOT 57) and the presence of ketones in the urine could suggest acute pancreatitis, especially if the patient has a history of gallstones (suggested by the presence of calcium oxalate crystals) or hypertriglyceridemia.
- Dehydration and Electrolyte Imbalance: The patient's symptoms of nausea and vomiting could lead to dehydration and electrolyte imbalances, as evidenced by the low potassium level (3).
- Diabetic Ketoacidosis (DKA): The presence of glucose in the urine (100), ketones (80), and the clinical presentation could suggest DKA, particularly if the patient has a history of diabetes.
Do Not Miss Diagnoses
- Acute Hepatitis: Although less likely, acute hepatitis could present with elevated liver enzymes and should be considered, especially given the patient's symptoms and laboratory results.
- Obstructive Jaundice: The presence of bilirubin in the urine (100) could indicate obstructive jaundice, which would require prompt evaluation and treatment to prevent serious complications.
- Sepsis: Any patient presenting with persistent nausea and vomiting should be evaluated for sepsis, particularly if there are signs of infection or organ dysfunction.
Rare Diagnoses
- Porphyria: This group of disorders can present with abdominal pain, nausea, vomiting, and neurological symptoms, and could be considered if other diagnoses are ruled out.
- Zollinger-Ellison Syndrome: A rare condition characterized by excessive gastric acid production, leading to severe vomiting and abdominal pain, which could be considered if other causes are excluded.