Differential Diagnosis for 82-year-old Male with Acute Confusion
- Single most likely diagnosis:
- Delirium: The patient's acute onset of confusion, disorientation (believing his car was stolen despite not having it since the stroke), and fluctuating thoughts (feeling his family does not love him) are classic symptoms of delirium. The wife's concern about dehydration or a UTI also points towards a possible acute medical issue triggering delirium.
- Other Likely diagnoses:
- Urinary Tract Infection (UTI): Despite the patient denying urinary symptoms, UTIs can present atypically in the elderly, leading to confusion without the typical symptoms of dysuria or frequency.
- Dehydration: Given the patient's age and history of diabetes, dehydration could easily occur and lead to confusion, especially if there has been any change in fluid intake or output.
- Medication Side Effects: The patient is likely on multiple medications for his various chronic conditions, and changes in medication or dosages could lead to confusion.
- Electrolyte Imbalance: Conditions like hyperglycemia (from diabetes) or hyponatremia (from various causes including medication side effects or heart failure) could cause confusion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Sepsis: Although the patient does not report recent illness, diarrhea, vomiting, or urinary symptoms, sepsis can present subtly in the elderly and is a life-threatening condition.
- Intracranial Hemorrhage or New CVA: Given the patient's history of CVA, a new stroke or intracranial hemorrhage could present with confusion and must be ruled out.
- Hypoglycemia: As a diabetic patient, hypoglycemia could cause confusion and is easily treatable but dangerous if missed.
- Rare diagnoses:
- Encephalitis or Meningitis: These are less common but could present with acute confusion and would require prompt diagnosis and treatment.
- Vitamin B12 Deficiency: This can cause neurological symptoms including confusion, especially in the elderly, but is less likely given the acute presentation.
- Hyperosmolar Hyperglycemic State (HHS): A serious complication of diabetes that can cause confusion among other symptoms, though typically there would be more prominent signs of hyperglycemia.