Differential Diagnosis

The patient is a 90+ year old male with a pacemaker, presenting with shaking, possible hypothermia, and no recent meals. The following differential diagnoses are considered:

• Single most likely diagnosis:
  • Hypoglycemia: The patient's shaking and possible hypothermia could be indicative of low blood sugar, especially given that he hasn't eaten recently.
• Other Likely diagnoses:
  • Dehydration: The patient's symptoms could also be related to dehydration, particularly if he hasn't been drinking enough fluids.
  • Electrolyte imbalance: The patient's age and possible underlying medical conditions make electrolyte imbalance a plausible diagnosis.
  • Urinary tract infection (UTI): The patient's age and symptoms such as possible pain while urinating make UTI a possible diagnosis.
  • Sepsis: Although less likely, sepsis is a possible diagnosis given the patient's age and symptoms such as shaking and possible hypothermia.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Septic shock: This is a life-threatening condition that requires immediate medical attention.
  • Cardiac arrhythmia: The patient's pacemaker and age make cardiac arrhythmia a possible diagnosis that should not be missed.
  • Pulmonary embolism: Although less likely, pulmonary embolism is a possible diagnosis that could be deadly if missed.
• Rare diagnoses:
  • Hypothyroidism: Although less likely, hypothyroidism could be a possible diagnosis given the patient's symptoms such as shaking and possible hypothermia.
  • Adrenal insufficiency: This is a rare but possible diagnosis that could present with similar symptoms.
  • Neurological disorders (e.g. Parkinson's disease): Although less likely, neurological disorders could be a possible diagnosis given the patient's symptoms such as shaking.