Differential Diagnosis for a 20-month-old with Vomiting and a BUN/Creatinine Ratio of 38.3
- Single most likely diagnosis:
- Gastroenteritis: This is the most likely diagnosis given the symptoms of vomiting and the elevated BUN/creatinine ratio, which can indicate dehydration, a common complication of gastroenteritis in children.
- Other Likely diagnoses:
- Dehydration: This can be a direct consequence of vomiting and can lead to the observed laboratory findings.
- Urinary Tract Infection (UTI): Although less common in this age group without other symptoms, a UTI could potentially cause an elevation in the BUN/creatinine ratio.
- Acute Gastrointestinal Infection with dehydration: Similar to gastroenteritis, other infections causing vomiting can lead to dehydration and the observed lab results.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Diabetic Ketoacidosis (DKA): Although less likely without a history of diabetes, DKA can present with vomiting and dehydration, and the BUN/creatinine ratio can be elevated. Missing this diagnosis can be fatal.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause vomiting and dehydration. It's a surgical emergency.
- Volvulus or other intestinal obstruction: These conditions can cause severe vomiting and dehydration, and require immediate surgical intervention.
- Rare diagnoses:
- Congenital adrenal hyperplasia: A rare condition that can cause dehydration and electrolyte imbalances, potentially leading to an elevated BUN/creatinine ratio.
- Renal vein thrombosis: A rare condition in children that can cause acute kidney injury, presenting with vomiting and dehydration among other symptoms.
- Inborn errors of metabolism: Certain metabolic disorders can present with vomiting, dehydration, and abnormal laboratory findings, including an elevated BUN/creatinine ratio.