Differential Diagnosis for Stuporous Patient with COPD and Alcohol Use Disorder
Single Most Likely Diagnosis
- Benzodiazepine Overdose: The patient received 2 doses of Ativan (lorazepam), a benzodiazepine, which can cause significant sedation, especially in the context of alcohol use disorder that may impair liver function and increase the risk of benzodiazepine toxicity.
Other Likely Diagnoses
- Alcohol Withdrawal: Given the patient's history of alcohol use disorder, alcohol withdrawal should be considered, especially if the patient has not had a recent drink. However, the timing and the fact that the patient received benzodiazepines (which are used to treat alcohol withdrawal) make this less likely as the primary cause of stupor.
- COPD Exacerbation: Although less directly related to the immediate presentation of stupor after receiving Ativan, a COPD exacerbation could lead to hypoxia or hypercapnia, contributing to altered mental status. However, this would typically be accompanied by other symptoms such as increased dyspnea or cough.
Do Not Miss Diagnoses
- Opioid Overdose: Even though not directly mentioned, opioid use is common among individuals with substance use disorders, and opioid overdose can cause respiratory depression leading to stupor or coma. Naloxone administration could be lifesaving.
- Hypoxic-Ischemic Encephalopathy: This could result from severe respiratory depression leading to hypoxia, which is a possibility given the patient's COPD and the sedative effects of Ativan and alcohol.
- Intracranial Hemorrhage or Trauma: Especially in the context of alcohol use disorder, where falls and head injuries are more common, an intracranial hemorrhage or trauma could present with altered mental status.
Rare Diagnoses
- Wernicke's Encephalopathy: A complication of alcohol use disorder characterized by confusion, ataxia, and ophthalmoplegia. While it's a serious condition, the acute onset of stupor after benzodiazepine administration makes this less likely as the primary diagnosis.
- Non-Convulsive Status Epilepticus: This is a rare condition that could present with altered mental status without overt seizure activity. It would be an unusual first consideration but should be kept in mind if other explanations are ruled out.