Differential Diagnosis

• Single most likely diagnosis
  • Alcoholic Ketoacidosis: This condition is likely given the patient's alcohol intake, new confusion (possibly due to altered mental status from ketoacidosis), high lactate levels (indicative of metabolic acidosis), and mild elevation in creatinine kinase (could be from alcohol-related muscle injury). The low potassium is also consistent with this diagnosis, as ketoacidosis can lead to potassium depletion.
• Other Likely diagnoses
  • Ethanol Withdrawal: The patient's confusion and history of alcohol intake could suggest ethanol withdrawal, especially if the patient has been drinking heavily and then stopped or reduced intake. However, the high lactate and specific lab findings might not fully align with typical withdrawal symptoms.
  • Diabetic Ketoacidosis (DKA): Although less likely without a known history of diabetes, DKA could present with confusion, high lactate (in the context of diabetic ketoacidosis, lactate might not be as high as in other conditions but can still be elevated), and electrolyte imbalances including low potassium. The absence of a past medical history of diabetes makes this less likely but not impossible.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Methanol or Ethylene Glycol Poisoning: These conditions can present with high lactate levels, confusion, and metabolic acidosis. Although the history provided mentions alcohol intake, it's crucial to consider other forms of intoxication, especially given the potential for severe and irreversible outcomes if not promptly treated.
  • Sepsis: Sepsis can cause confusion, elevated lactate (lactic acidosis), and electrolyte disturbances. While the provided information does not directly suggest an infectious source, sepsis is a condition that must be considered due to its high mortality rate if not promptly recognized and treated.
• Rare diagnoses
  • Mitochondrial Myopathies: These are a group of disorders that affect the mitochondria, leading to muscle weakness and other systemic symptoms. Some forms can present with lactic acidosis and elevated creatinine kinase, but they are much rarer and typically have a more chronic presentation.
  • Malignant Hyperthermia: This is a rare but life-threatening medical emergency that can be triggered by certain drugs used in general anesthesia. It presents with high fever, muscle rigidity, and elevated creatinine kinase. While the scenario does not directly suggest recent anesthesia exposure, it's an important consideration in any case of unexplained high fever and muscle enzyme elevation.