Differential Diagnosis
The provided laboratory results suggest a complex clinical picture. Here's a differential diagnosis based on the given information:
Single most likely diagnosis
- Diabetic Ketoacidosis (DKA): The presence of glucose in the urine (100), ketones (80), and the clinical context of elevated liver enzymes (ALT-SGPT 120, AST-SGOT 57) and low potassium (3) are highly suggestive of DKA, especially considering the metabolic derangements and potential liver involvement.
Other Likely diagnoses
- Acute Pancreatitis: Although the lipase level is within normal limits (9), the clinical presentation and the presence of ketones could still suggest pancreatitis, especially if the lipase was drawn late in the course of the disease.
- Hepatocellular Injury: The elevated liver enzymes (ALT-SGPT 120, AST-SGOT 57) could indicate hepatocellular injury from various causes, including but not limited to viral hepatitis, drug-induced liver injury, or ischemic hepatitis.
- Urinary Tract Infection (UTI) or Contamination: The presence of squamous epithelial cells (moderate) and calcium oxalate crystals could suggest a UTI or contamination of the urine sample.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic Shock: Although not directly indicated by the lab results, the combination of metabolic disturbances and potential organ dysfunction (elevated liver enzymes) warrants consideration of sepsis, especially if the patient shows signs of shock or severe infection.
- Acute Liver Failure: The elevated liver enzymes and bilirubin in the urine could be indicative of acute liver failure, which is a medical emergency.
Rare diagnoses
- Wilson's Disease: A rare genetic disorder that leads to copper accumulation in the liver, potentially causing liver dysfunction and could explain the elevated liver enzymes.
- Type 1 Diabetes with Autoimmune Hepatitis: Although rare, the combination of new-onset diabetes (suggested by glucose in the urine) and autoimmune hepatitis could present with similar laboratory findings.
- Primary Biliary Cholangitis: An autoimmune disease of the liver that could lead to cholestasis (indicated by bilirubin in the urine) and elevated liver enzymes, though it is less likely given the acute presentation.