Differential Diagnosis for Patient with Persistent Nausea and Vomiting
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 make CHS a strong consideration.
Other Likely Diagnoses
- Gastroenteritis: Although the patient's symptoms could be consistent with gastroenteritis, the absence of diarrhea and the presence of other laboratory findings (e.g., elevated liver enzymes) make this diagnosis less likely.
- Pancreatitis: The patient's abdominal pain (implied by nausea and vomiting) and elevated glucose in the urine could suggest pancreatitis, but the lack of specific pancreatic enzyme elevations (e.g., amylase, lipase) makes this diagnosis less certain.
- Dehydration and Electrolyte Imbalance: The patient's symptoms of nausea and vomiting for an extended period could lead to dehydration and electrolyte imbalances, as evidenced by the low potassium level.
Do Not Miss Diagnoses
- Acute Hepatitis: The elevated liver enzymes (ALT and AST) could indicate acute hepatitis, which would require prompt identification and treatment to prevent liver damage.
- Diabetic Ketoacidosis (DKA): The presence of glucose, ketones, and bilirubin in the urine, along with the patient's symptoms, could suggest DKA, a life-threatening condition that requires immediate treatment.
- Ureteral Obstruction or Kidney Stones: The presence of calcium oxalate crystals in the urine could indicate a ureteral obstruction or kidney stones, which would require urgent evaluation and treatment to prevent kidney damage.
Rare Diagnoses
- Addisonian Crisis: Although rare, the patient's symptoms of nausea, vomiting, and electrolyte imbalance could be consistent with an Addisonian crisis, which would require prompt recognition and treatment with corticosteroids.
- Zollinger-Ellison Syndrome: This rare condition, characterized by excessive gastric acid production, could cause severe nausea and vomiting, but would be unusual in the absence of other specific symptoms (e.g., diarrhea, abdominal pain).