Differential Diagnosis
- Single most likely diagnosis
- Starvation/Kwashiorkor: The patient has not eaten for 10-15 days, which is a significant period of malnutrition. This condition can lead to severe physical and mental health issues, including weakness, fatigue, and potentially life-threatening complications if not addressed promptly.
- Other Likely diagnoses
- Depression: The patient's lack of motivation to eat or engage in activities, as evidenced by lying on the floor and not leaving the house, could be indicative of severe depression.
- Dementia: The patient's behavior and lack of self-care could also suggest dementia, especially if there's a history of cognitive decline.
- Dehydration: Prolonged lack of food intake can also lead to dehydration, which may not be immediately apparent without specific symptoms like tachycardia or tachypnea but should be considered.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although the chest x-ray is normal and there's no tachypnea, pulmonary embolism can sometimes present atypically, especially in elderly or debilitated patients. It's crucial to consider this diagnosis due to its high mortality rate if missed.
- Infection/Septicemia: The absence of tachycardia or tachypnea does not rule out infection, particularly in elderly or immunocompromised patients, who may have a blunted response to infection.
- Acute Coronary Syndrome: While the ECG is normal, acute coronary syndrome (ACS) can occasionally present without typical ECG changes, especially in women or diabetic patients. The patient's prolonged fasting state could also potentially lead to electrolyte imbalances that might predispose to cardiac arrhythmias.
- Rare diagnoses
- Hyperthyroidism: Although less likely, severe hyperthyroidism can lead to significant weight loss, decreased appetite, and fatigue. However, other symptoms such as tachycardia, tremors, or exophthalmos are typically present.
- Addison's Disease: This rare endocrine disorder can cause anorexia, weight loss, and fatigue among other symptoms. The lack of typical symptoms like hypotension or hyperkalemia makes it less likely but not impossible.