Differential Diagnosis for a 31-year-old Female at 8 Weeks Gestation
The patient presents with persistent vomiting, inability to tolerate oral intake, dehydration, diffuse body aches, and headache. Considering her history of chronic kidney disease and prior diagnosis of hyperemesis gravidarum, the following differential diagnoses are possible:
- Single most likely diagnosis
- Hyperemesis gravidarum: Given her past history of hyperemesis gravidarum and the current symptoms of persistent vomiting and dehydration, this diagnosis is highly likely. The condition is characterized by excessive vomiting during pregnancy, often leading to dehydration and electrolyte imbalances.
- Other Likely diagnoses
- Dehydration and electrolyte imbalance: The patient's inability to tolerate oral intake and reported dehydration make this a likely diagnosis. Electrolyte imbalances can occur due to persistent vomiting.
- Urinary tract infection (UTI): Although the patient denies abdominal pain, a UTI can cause systemic symptoms such as body aches and headache. Her history of chronic kidney disease increases her risk for UTIs.
- Pregnancy-related acute kidney injury: The patient's history of chronic kidney disease and current dehydration increase her risk for acute kidney injury.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Eclampsia: Although the patient is only at 8 weeks gestation, eclampsia can occur at any time during pregnancy. Her history of chronic kidney disease and current symptoms of headache and body aches make it essential to consider this diagnosis.
- Sepsis: The patient's symptoms of body aches, headache, and dehydration could be indicative of sepsis, particularly if she has an underlying infection.
- Acute kidney injury due to other causes (e.g., medication, toxins): The patient's history of chronic kidney disease makes her more susceptible to acute kidney injury from various causes.
- Rare diagnoses
- Molar pregnancy: Although rare, a molar pregnancy can cause excessive vomiting and dehydration. However, this diagnosis is less likely given the patient's prior normal pregnancies.
- Thyroid storm: The patient's symptoms of vomiting, dehydration, and body aches could be indicative of a thyroid storm, although this is a rare condition.
Recommended Labs in the Emergency Department
To evaluate the patient's condition and narrow down the differential diagnosis, the following labs should be ordered:
- Complete blood count (CBC)
- Basic metabolic panel (BMP) to evaluate electrolyte levels and kidney function
- Urinalysis to check for UTI or kidney injury
- Blood urea nitrogen (BUN) and creatinine to assess kidney function
- Thyroid-stimulating hormone (TSH) to rule out thyroid abnormalities
- Liver function tests (LFTs) to evaluate liver function
- Beta-hCG to confirm pregnancy and evaluate for potential complications
- Blood cultures and lactate level if sepsis is suspected
- Urine culture if UTI is suspected