Differential Diagnosis
The patient's presentation of hypothermia (T 35.6), hypotension (low BP), hyperkalemia (high K), and hypoglycemia (low glucose) following a hemicolectomy, with a known history of steroid-dependent asthma, suggests an endocrine emergency. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Adrenal insufficiency: This is the most likely diagnosis given the patient's history of steroid-dependent asthma. Chronic steroid use can suppress the hypothalamic-pituitary-adrenal axis, leading to adrenal insufficiency. The stress of surgery can exacerbate this condition, resulting in hypotension, hypoglycemia, and hyperkalemia.
- Other Likely diagnoses
- Sepsis: Although less directly related to the patient's steroid use, sepsis is a common post-surgical complication that can cause hypotension, hypothermia, and alterations in glucose and potassium levels.
- Hypothyroidism: Though less likely than adrenal insufficiency, hypothyroidism could contribute to hypothermia and potentially hypoglycemia, especially if the patient has untreated or undertreated hypothyroidism.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Thyroid storm: Although the patient's presentation does not strongly suggest a thyroid storm (which typically includes hyperthermia, hypertension, and tachycardia), it is crucial not to miss this diagnosis due to its high mortality rate. However, the patient's hypothermia and hypotension make this less likely.
- Pheochromocytoma crisis: This is another endocrine emergency that could present with hypoglycemia and electrolyte imbalances, though it typically includes hypertension and tachycardia, making it less likely in this scenario.
- Rare diagnoses
- Other endocrine tumors or disorders: Rarely, other endocrine disorders could lead to similar presentations, including insulinomas causing hypoglycemia or aldosterone-producing adenomas leading to hyperkalemia, though these would be less likely given the patient's history and presentation.