Differential Diagnosis for Orthostatic Hypotension
The patient, Avery Witherell, presents with a blood pressure of 114/72 mmHg in the supine position and 105/68 mmHg when sitting, indicating orthostatic hypotension. Here's a differential diagnosis organized into categories:
- Single Most Likely Diagnosis
- Dehydration: This is a common cause of orthostatic hypotension, especially if the patient has not been drinking enough fluids or has been experiencing excessive fluid loss (e.g., due to vomiting, diarrhea, or excessive sweating).
- Other Likely Diagnoses
- Medication side effects: Certain medications, such as diuretics, beta-blockers, and certain antidepressants, can cause orthostatic hypotension as a side effect.
- Autonomic nervous system dysfunction: Conditions like diabetes, amyloidosis, or multiple system atrophy can damage the autonomic nervous system, leading to orthostatic hypotension.
- Anemia: Severe anemia can reduce the amount of oxygen being delivered to tissues, leading to symptoms of orthostatic hypotension.
- Do Not Miss Diagnoses
- Hemorrhage: Internal bleeding can cause orthostatic hypotension due to decreased blood volume. This is a life-threatening condition that requires immediate attention.
- Cardiac tamponade: Fluid accumulation in the pericardial sac can compress the heart, leading to decreased cardiac output and orthostatic hypotension.
- Sepsis: Septic shock can cause orthostatic hypotension due to vasodilation and decreased blood pressure.
- Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause orthostatic hypotension due to intermittent release of catecholamines.
- Addison's disease: A rare endocrine disorder that can cause orthostatic hypotension due to adrenal insufficiency.
- Dysautonomia: A rare condition characterized by autonomic nervous system dysfunction, which can cause orthostatic hypotension.
Each of these diagnoses has a brief justification, and it's essential to consider them when evaluating a patient with orthostatic hypotension. A thorough medical history, physical examination, and diagnostic tests can help determine the underlying cause of the patient's symptoms.