Differential Diagnosis for Unresponsive 23-year-old Male

Given the laboratory results, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • C. Diabetic ketoacidosis (DKA): The patient's glucose level is significantly elevated at 817 mg/dL, which is a hallmark of DKA. The presence of hyperglycemia, along with the patient's unresponsive state, suggests severe metabolic derangement consistent with DKA.

• Other Likely Diagnoses

  • Hypernatremia (B): The sodium level is slightly elevated at 144 mmol/L, which could contribute to the patient's altered mental status. However, this finding alone does not fully explain the patient's condition.
  • Acute Kidney Injury (AKI): The elevated creatinine level (2.3 mg/dL) and BUN (49 mg/dL) suggest impaired renal function, which could be contributing to the patient's unresponsive state.

• Do Not Miss Diagnoses

  • Hypocalcemia (A): Although the calcium level is within the normal range (7.8 mg/dL), it's essential to consider hypocalcemia in the context of critically ill patients, as it can have significant clinical implications. However, in this case, it's not directly supported by the laboratory findings.
  • Severe Hyperkalemia: The potassium level is elevated at 5.7 mmol/L, which can be life-threatening if not addressed promptly. Although not immediately lethal at this level, it warrants close monitoring and potential intervention.

• Rare Diagnoses

  • Other endocrine disorders: Although less likely, other endocrine disorders (e.g., adrenal insufficiency, thyroid storm) could potentially explain the patient's presentation. However, these conditions would typically require additional specific laboratory findings or clinical clues not provided in the scenario.
  • Toxic ingestions: Certain toxic ingestions (e.g., salicylates, methanol) can cause severe metabolic derangements and altered mental status. However, these diagnoses would typically require specific historical or laboratory evidence not presented in the case.