Differential Diagnosis for Sudden Onset of Glucose Intolerance in Patients Receiving Total Parenteral Nutrition

• Single Most Likely Diagnosis
  • B. Sepsis: Sepsis is a common complication in patients receiving total parenteral nutrition (TPN) and can lead to glucose intolerance due to the release of stress hormones like cortisol and adrenaline, which increase glucose production and decrease insulin sensitivity.
• Other Likely Diagnoses
  • C. Hypophosphatemia: Hypophosphatemia can occur in patients receiving TPN, especially if the phosphate content is inadequate. It can cause glucose intolerance by impairing insulin secretion and increasing glucose production in the liver.
  • A. Diabetes mellitus: Although less common as a new onset condition in this context, pre-existing or stress-induced diabetes mellitus can manifest as glucose intolerance in patients on TPN.
• Do Not Miss Diagnoses
  • D. Adrenal insufficiency: Although rare, adrenal insufficiency can cause glucose intolerance and is critical to diagnose early because it can be life-threatening if not treated promptly. The stress of illness and certain medications can precipitate adrenal crisis in susceptible individuals.
• Rare Diagnoses
  • Other rare causes of glucose intolerance in this setting might include pancreatic injury or disease, certain medications (other than those directly related to TPN), and endocrine disorders other than diabetes or adrenal insufficiency. These would be considered based on individual patient factors and the presence of other specific symptoms or laboratory findings.