Differential Diagnosis for Intractable Nausea and Vomiting
Single Most Likely Diagnosis
- Hypochloremic Metabolic Alkalosis: This condition is likely due to the patient's history of duodenal ulcer disease and the use of H2-receptor blocking agents, which can lead to increased gastric pH and subsequent hypochloremia. The patient's symptoms of intractable nausea and vomiting also support this diagnosis, as they can cause loss of hydrochloric acid and lead to metabolic alkalosis. The expected serum electrolyte findings would be low chloride levels, low potassium levels, and elevated bicarbonate levels, which is closest to option B) 140 80 2.5 40.
Other Likely Diagnoses
- Gastrointestinal Obstruction: The patient's symptoms of intractable nausea and vomiting could also be indicative of a gastrointestinal obstruction, which can cause severe vomiting and lead to electrolyte imbalances. The expected serum electrolyte findings would depend on the location and duration of the obstruction.
- Pyloric Stenosis: This condition can cause gastric outlet obstruction, leading to severe vomiting and electrolyte imbalances. The expected serum electrolyte findings would be similar to those of hypochloremic metabolic alkalosis.
Do Not Miss Diagnoses
- Adrenal Insufficiency: Although less likely, adrenal insufficiency can cause severe vomiting, hypotension, and electrolyte imbalances. It is essential to consider this diagnosis, as it can be life-threatening if missed. The expected serum electrolyte findings would be hyponatremia, hyperkalemia, and metabolic acidosis.
- Diabetic Ketoacidosis: This condition can cause severe vomiting, dehydration, and electrolyte imbalances. Although the patient's glucose level is not provided, it is crucial to consider this diagnosis, as it can be life-threatening if missed. The expected serum electrolyte findings would be hyperglycemia, metabolic acidosis, and variable electrolyte levels.
Rare Diagnoses
- Zollinger-Ellison Syndrome: This rare condition can cause severe peptic ulcer disease, diarrhea, and electrolyte imbalances. Although less likely, it is essential to consider this diagnosis in patients with a history of duodenal ulcer disease and severe symptoms.
- Congenital Chloride Diarrhea: This rare condition can cause severe diarrhea, vomiting, and electrolyte imbalances. Although unlikely, it is essential to consider this diagnosis in patients with severe and unexplained electrolyte imbalances.