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 support this diagnosis.
Other Likely Diagnoses
- Acute Pancreatitis: Although the lipase level is within normal limits, the patient's symptoms of nausea and vomiting, along with the presence of ketones in the urine, could suggest pancreatitis. However, the normal lipase level makes this diagnosis less likely.
- Gastroenteritis: The patient's symptoms of nausea and vomiting could be indicative of a viral or bacterial gastroenteritis. The presence of squamous epithelial cells in the urine may suggest dehydration, which can occur with gastroenteritis.
- Dehydration with Secondary Renal Impairment: The patient's symptoms and laboratory results, including low potassium and elevated glucose in the urine, may indicate dehydration with secondary renal impairment.
Do Not Miss Diagnoses
- Diabetic Ketoacidosis (DKA): Although the patient's glucose level is not provided, the presence of glucose and ketones in the urine, along with nausea and vomiting, could suggest DKA. This is a life-threatening condition that requires prompt diagnosis and treatment.
- Uremic Gastritis: The patient's laboratory results, including elevated creatinine (not provided) and uremia, could suggest uremic gastritis, which can cause nausea and vomiting.
- Biliary Colic or Cholecystitis: The patient's symptoms of nausea and vomiting, along with the presence of bilirubin in the urine, could suggest a biliary tract disorder, such as biliary colic or cholecystitis.
Rare Diagnoses
- Addisonian Crisis: The patient's symptoms of nausea and vomiting, along with low potassium, could suggest an Addisonian crisis, which is a life-threatening condition caused by adrenal insufficiency.
- Zollinger-Ellison Syndrome: The patient's symptoms of nausea and vomiting, along with elevated glucose in the urine, could suggest Zollinger-Ellison syndrome, a rare condition characterized by excessive gastric acid production.