Differential Diagnosis
- Single Most Likely Diagnosis
- Diabetic Ketoacidosis (DKA): The presence of high glucose levels (>500) in the urine, significant ketones (40), and elevated blood glucose (228) strongly suggests DKA. The patient's presentation, including the laboratory findings, is consistent with this diagnosis.
- Other Likely Diagnoses
- Urinary Tract Infection (UTI): The presence of nitrate-positive, trace leukocytes, and protein in the urine, along with an elevated CRP (130), suggests an infectious process. The detection of Candida glabrata krusei further supports this, as it can cause UTIs, especially in diabetic patients.
- Sepsis: With an elevated WBC count (12.7), high CRP (130), and the presence of an infection (as suggested by the UTI findings and positive Candida detection), sepsis should be considered, especially if the patient shows signs of systemic inflammation.
- Do Not Miss Diagnoses
- Septic Shock: Although the patient's blood pressure is not provided, the combination of suspected infection (UTI and Candida), elevated inflammatory markers (CRP and WBC), and the presence of DKA could potentially lead to septic shock, a life-threatening condition.
- Emphysematous Pyelonephritis: This is a severe infection of the kidney, which can occur in diabetic patients and is associated with high morbidity and mortality. The presence of DKA, UTI signs, and significant leukocytosis makes this a critical diagnosis not to miss.
- Rare Diagnoses
- Malignancy: Although less likely, the presence of unexplained proteinuria, hematuria, and an elevated WBC count could, in rare cases, be associated with a malignancy affecting the urinary tract. However, this would be less likely given the other findings more strongly suggestive of infectious and metabolic disorders.