Differential Diagnosis for 88-year-old Male with New Onset Fatigue and Sleeping More

Single Most Likely Diagnosis

• Chronic Liver Disease: The patient's high alkaline phosphatase (343), elevated AST (82), and slightly elevated total bilirubin (1.4) suggest liver dysfunction. The low albumin (2.5) and high globulin (4.4) levels also support this diagnosis, as they can indicate a decrease in liver synthetic function and an increase in immune response, respectively.

Other Likely Diagnoses

• Diabetes Mellitus: The patient's high glucose level (118) could indicate diabetes mellitus, which is a common condition in the elderly and can cause fatigue.
• Chronic Kidney Disease (CKD): Although the patient's creatinine level is only slightly elevated (1.43), the low eGFR (47) suggests some degree of kidney impairment, which can contribute to fatigue and other symptoms.
• Hypothyroidism: Although not directly indicated by the lab results, hypothyroidism is a common condition in the elderly that can cause fatigue, sleepiness, and other non-specific symptoms.

Do Not Miss Diagnoses

• Sepsis: Although the patient's white blood cell count is normal (7.1), the high absolute lymphocytes (4026) and slightly elevated monocytes (568) could indicate an underlying infection. Sepsis is a life-threatening condition that requires prompt diagnosis and treatment.
• Malignancy: The patient's low albumin (2.5) and high globulin (4.4) levels could also indicate a malignancy, such as multiple myeloma or lymphoma. Although less likely, these conditions can cause fatigue, weight loss, and other non-specific symptoms.
• Adrenal Insufficiency: This is a rare but potentially life-threatening condition that can cause fatigue, weakness, and other non-specific symptoms. Although not directly indicated by the lab results, adrenal insufficiency should be considered in the differential diagnosis.

Rare Diagnoses

• Hemochromatosis: This is a rare genetic disorder that can cause liver dysfunction, fatigue, and other symptoms. Although less likely, hemochromatosis should be considered in the differential diagnosis, especially given the patient's elevated liver enzymes.
• Wilson's Disease: This is a rare genetic disorder that can cause liver dysfunction, fatigue, and other symptoms. Although less likely, Wilson's disease should be considered in the differential diagnosis, especially given the patient's elevated liver enzymes.