Differential Diagnosis

• Single most likely diagnosis
  • Diabetic Ketoacidosis (DKA) with a urinary tract infection (UTI): The presence of glucose +4, ketones +2, and leukocytes 500 in the urine suggests DKA complicated by a UTI. The yeast many finding could indicate a fungal infection, but in the context of DKA, it's more likely that the yeast is a contaminant or a less significant finding.
• Other Likely diagnoses
  • Urinary Tract Infection (UTI) with glucosuria: The high leukocyte count and presence of yeast could indicate a UTI, potentially with a fungal component. Glucosuria (+4) could be due to uncontrolled diabetes or another cause of hyperglycemia.
  • Pyelonephritis: The high WBC count (TNTC) and leukocytes in the urine suggest an upper urinary tract infection, which could be pyelonephritis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sepsis: Although less likely, the presence of a high WBC count and potential infection sources (UTI, DKA) necessitates consideration of sepsis, which is a life-threatening condition.
  • Emphysematous Pyelonephritis: This is a rare but serious infection of the kidney, often associated with diabetes. Although less likely, it's crucial to consider due to its high mortality rate.
• Rare diagnoses
  • Malignancy (e.g., bladder or renal cancer): Although rare, malignancies can cause urinary symptoms and abnormalities in the urinalysis. However, they are less likely given the acute presentation and presence of infection signs.
  • Tuberculosis: Genitourinary tuberculosis can cause urinary symptoms and abnormalities, including leukocytes and glucosuria, but it's a rare diagnosis in many populations.