Differential Diagnosis for 68 F with hx of HTN, COPD

Single Most Likely Diagnosis

• Chronic Kidney Disease (CKD) with early diabetic changes: The patient has a history of hypertension, which is a major risk factor for CKD. The elevated BUN/Creatinine ratio and slightly decreased eGFR suggest some degree of kidney impairment. The high glucose level may indicate early diabetic changes, which could be contributing to the kidney disease.

Other Likely Diagnoses

• Dehydration: The patient's low sodium level and elevated BUN/Creatinine ratio could be indicative of dehydration, which is common in elderly patients, especially those with COPD.
• Malnutrition or Malabsorption: The low Vitamin B-12 level could be due to malnutrition or malabsorption, which is common in elderly patients or those with chronic diseases like COPD.
• Early Diabetes Mellitus: The high glucose level could be indicative of early diabetes mellitus, which would require further evaluation and management.

Do Not Miss Diagnoses

• Adrenal Insufficiency: Although less likely, adrenal insufficiency could cause hypotension, hyponatremia, and hyperkalemia. Given the patient's history of COPD and potential for steroid use, this diagnosis should not be missed.
• Pulmonary Embolism: COPD patients are at increased risk for pulmonary embolism, which could cause dehydration, electrolyte imbalances, and other laboratory abnormalities.

Rare Diagnoses

• Multiple Myeloma: The high total protein level could be indicative of a paraproteinemia, such as multiple myeloma. Although rare, this diagnosis should be considered in patients with unexplained laboratory abnormalities.
• Pernicious Anemia: The low Vitamin B-12 level could be due to pernicious anemia, a rare autoimmune disorder that causes malabsorption of Vitamin B-12.