What could be the cause of recurrent episodes of syncope, diaphoresis, and loss of motor control, particularly when occurring on an empty stomach and after consuming substances such as beer, weed, and cigarettes, in a previously healthy individual with a history of significant weight loss and current treatment with Azithromycin (azithromycin) for a viral fever?

Differential Diagnosis

• Single most likely diagnosis
  • Hypoglycemia: The patient's symptoms of vision blackout, sweating, loss of motor control, and improvement after eating food suggest hypoglycemia, especially given the history of eating very little and being on an empty stomach. The physical activity, alcohol, and substance use may have further lowered blood sugar levels.
• Other Likely diagnoses
  • Dehydration: The patient's symptoms of sweating, weakness, and improvement after eating food may also be related to dehydration, especially given the physical activity in the sun and lack of food intake.
  • Orthostatic hypotension: The patient's symptoms of dizziness, sweating, and loss of motor control may be related to orthostatic hypotension, especially given the history of significant weight loss and potential dehydration.
  • Substance-induced hypotension: The patient's use of substances such as alcohol, weed, and cigarettes may have contributed to hypotension, especially in combination with physical activity and an empty stomach.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cardiac arrhythmia: Although the patient has no pre-existing conditions, cardiac arrhythmia is a potentially life-threatening condition that could cause symptoms such as loss of consciousness and motor control.
  • Seizure disorder: The patient's symptoms of vision blackout, loss of motor control, and eye rolling could be indicative of a seizure disorder, which would require prompt medical attention.
  • Infectious causes: Although the patient is taking Azithromycin for a viral fever, it is possible that the infection could be causing more severe symptoms, such as sepsis or meningitis, which would require immediate medical attention.
• Rare diagnoses
  • Adrenal insufficiency: The patient's symptoms of weakness, sweating, and loss of motor control could be related to adrenal insufficiency, although this is a rare condition.
  • Pheochromocytoma: The patient's symptoms of sweating, weakness, and loss of motor control could be related to pheochromocytoma, a rare tumor of the adrenal gland that causes excessive catecholamine production.
  • Autonomic dysfunction: The patient's symptoms of orthostatic hypotension, sweating, and loss of motor control could be related to autonomic dysfunction, a rare condition that affects the autonomic nervous system.