Differential Diagnosis for 23-year-old Unresponsive Male

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

• Single Most Likely Diagnosis
  • 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. The elevated BUN and creatinine levels indicate possible dehydration and renal impairment, which are common in DKA.
• Other Likely Diagnoses
  • Severe Hyperglycemia: Although the patient's glucose level is extremely high, the absence of ketone measurements makes it difficult to confirm DKA. However, severe hyperglycemia itself can cause altered mental status and is a likely contributor to the patient's condition.
  • Acute Kidney Injury (AKI): The elevated creatinine level (2.3 mg/dL) suggests impaired renal function, which could be due to various causes, including dehydration, sepsis, or toxin exposure.
  • Electrolyte Imbalance: The patient's potassium level is elevated (5.7 mmol/L), which can be life-threatening if not addressed promptly. The combination of hyperkalemia and metabolic acidosis (indicated by low CO2 levels) suggests a complex electrolyte disturbance.
• Do Not Miss Diagnoses
  • Sepsis: Although not directly indicated by the laboratory results, sepsis can cause altered mental status, metabolic derangements, and organ dysfunction. It is essential to consider sepsis as a potential diagnosis, especially if the patient has a fever, hypotension, or other signs of infection.
  • Toxin Exposure: Certain toxins, such as salicylates or methanol, can cause severe metabolic acidosis, altered mental status, and elevated anion gaps. Although not directly suggested by the laboratory results, toxin exposure should be considered, especially if the patient has a history of substance abuse or exposure to hazardous materials.
• Rare Diagnoses
  • Fulminant Hepatic Failure: Although the liver function tests (AST, ALT, and alkaline phosphatase) are relatively normal, fulminant hepatic failure can cause altered mental status, coagulopathy, and metabolic derangements. However, this diagnosis is less likely given the absence of significant liver enzyme elevations.
  • Adrenal Insufficiency: Adrenal insufficiency can cause hypoglycemia, hyponatremia, and hyperkalemia. Although the patient's glucose level is elevated, adrenal insufficiency can occasionally present with hyperglycemia, especially if the patient has a concomitant infection or other stressor.

Regarding the presence of glucose in the urine, patients with glucose levels above 180-200 mg/dL are likely to have glucose in their urine due to the renal threshold for glucose reabsorption. In this case, the patient's glucose level is significantly elevated (817 mg/dL), making it highly likely that glucose is present in the urine. This is because the renal tubules are overwhelmed by the high glucose load, leading to glucose spillage into the urine.