Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: September 17, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for 65-year-old Female with Acute Presentation

Single Most Likely Diagnosis

  • Sepsis: The patient presents with tachycardia (HR 150), elevated lactate (7), and decreased urine output, which are indicative of septic shock. The elevated creatinine (2.9) and urea (54) suggest acute kidney injury, a common complication in sepsis. The low PO2 (65) could be due to pneumonia or acute respiratory distress syndrome (ARDS), which are common causes of sepsis.

Other Likely Diagnoses

  • Cardiogenic Shock: The patient's atrial fibrillation (AF) with rapid ventricular response could lead to cardiogenic shock, especially if there is underlying heart disease. The decreased urine output and elevated creatinine support this diagnosis.
  • Dehydration: Severe dehydration could lead to prerenal acute kidney injury, explaining the elevated creatinine and urea. However, the presence of AF and elevated lactate makes this less likely.
  • Pulmonary Embolism: A large pulmonary embolism could cause hypoxia (low PO2), tachycardia, and decreased urine output due to decreased cardiac output. However, the elevated lactate and kidney injury are less typical for pulmonary embolism.

Do Not Miss Diagnoses

  • Cardiac Tamponade: Although less likely, cardiac tamponade could cause decreased urine output, hypoxia, and tachycardia. It is crucial to consider this diagnosis due to its high mortality if missed.
  • Aortic Dissection: This is a life-threatening condition that could present with acute kidney injury, hypoxia, and tachycardia. The presence of AF increases the risk of aortic dissection.
  • Severe Hypovolemia due to Bleeding: Internal bleeding could lead to hypovolemic shock, presenting with tachycardia, decreased urine output, and elevated lactate. It is essential to rule out any source of bleeding.

Rare Diagnoses

  • Adrenal Insufficiency: Although rare, adrenal insufficiency could present with hypotension, decreased urine output, and elevated lactate. It is essential to consider this diagnosis, especially if the patient has a history of steroid use or adrenal disease.
  • Pheochromocytoma: A rare tumor that could cause episodic hypertension, tachycardia, and decreased urine output due to vasoconstriction. However, this diagnosis is less likely given the patient's presentation.

Related Questions

What is the best treatment for indigestion in a patient already taking a PPI (Proton Pump Inhibitor) and cimetidine?
What is the treatment for symptomatic cholelithiasis?
What are the essential components of a comprehensive dementia lab workup?
What is the recommended treatment for premature ovarian failure?
What alternative antidepressant can be given to a patient who experiences sexual dysfunction with Selective Serotonin Reuptake Inhibitor (SSRI) therapy?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question