Differential Diagnosis
- Single most likely diagnosis
- Pyridostigmine overdose: The patient recently increased the dose of pyridostigmine, which is used to treat myasthenia gravis. The symptoms of abdominal pain, dysphagia, diarrhea, shortness of breath, and diaphoresis are consistent with a cholinergic crisis, a known side effect of excessive pyridostigmine.
- Other Likely diagnoses
- Gastroenteritis: Although less likely given the recent increase in pyridostigmine, gastroenteritis (such as rotavirus) could cause abdominal pain, diarrhea, and dysphagia. However, the presence of shortness of breath and diaphoresis makes this less likely.
- Myasthenic crisis: This is a life-threatening complication of myasthenia gravis, characterized by respiratory failure. While the patient has shortness of breath, the normal pulse and presence of other symptoms such as abdominal pain and diarrhea make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Respiratory failure: Regardless of the underlying cause, the patient's shortness of breath requires close monitoring, as respiratory failure can be a life-threatening complication.
- Cardiac issues: Although the pulse is normal, cardiac issues such as myocardial ischemia or cardiomyopathy could present with shortness of breath and diaphoresis.
- Rare diagnoses
- Botulism: This rare condition can cause dysphagia, shortness of breath, and abdominal symptoms, but it is less likely given the patient's recent increase in pyridostigmine and the presence of diarrhea.
- Other cholinergic toxins: Exposure to other cholinergic toxins, such as organophosphates, could cause similar symptoms, but this is less likely given the patient's known increase in pyridostigmine.