Differential Diagnosis for 23 Year Old Female with Sporadic Vomiting

• Single Most Likely Diagnosis
  • Cyclical Vomiting Syndrome: This condition is characterized by recurrent, episodic vomiting that can be severe and is often preceded by a prodrome phase, which may include symptoms like nausea or abdominal pain, but in some cases, vomiting can occur without warning. The fact that the patient feels shaky afterwards and then fine could be related to the dehydration and electrolyte imbalance that follows vomiting.
• Other Likely Diagnoses
  • Gastroparesis: A condition where the stomach takes too long to empty its contents, leading to nausea, vomiting, and feeling full after eating only a small amount of food. The sporadic nature of the vomiting could be consistent with gastroparesis, especially if it's related to eating certain foods or at specific times.
  • Irritable Bowel Syndrome (IBS): Although primarily known for causing abdominal pain and changes in bowel movements, some patients with IBS can experience nausea and vomiting. The unpredictability of IBS symptoms could align with the sporadic vomiting described.
  • Anxiety or Stress-Related Vomiting: Stress and anxiety can trigger vomiting in some individuals, and the feeling of being shaky afterwards could be attributed to the physiological response to stress.
• Do Not Miss Diagnoses
  • Diabetic Ketoacidosis (DKA): Although the patient does not mention any known history of diabetes, DKA can present with vomiting, and the shakiness could be due to hypoglycemia or the body's response to ketones. Missing this diagnosis could be fatal.
  • Porphyria: A group of disorders that can result in acute episodes of severe abdominal pain, vomiting, and neurological symptoms. The intermittent nature of the symptoms and the feeling of being shaky could be indicative of a porphyria attack.
  • Addisonian Crisis: An acute, life-threatening complication of Addison's disease (adrenal insufficiency), which can present with vomiting, abdominal pain, and a feeling of extreme weakness or shakiness.
• Rare Diagnoses
  • Rumination Syndrome: A condition where food is regurgitated into the mouth without nausea or retching, often shortly after eating. While not typically associated with feeling shaky, it's a rare cause of vomiting that could be considered if other diagnoses are ruled out.
  • Chiari Malformation: A structural defect in the cerebellum that can cause a variety of symptoms, including vomiting, especially when associated with certain positions or activities. The shakiness could be related to other neurological symptoms associated with Chiari malformations.