Differential Diagnosis for a 62-year-old Female Feeling Drunk with Leukocytes in Urine but No Nitrates
- Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of leukocytes in the urine suggests an infection. Although nitrates are often positive in UTIs, their absence does not rule out the diagnosis. The feeling of being drunk could be attributed to a systemic response to the infection, such as sepsis, especially in an elderly patient.
- Other Likely Diagnoses
- Diabetic Ketoacidosis (DKA): This condition can cause a feeling of intoxication due to the metabolic disturbances. Leukocytes in the urine could be due to a concurrent UTI, which is common in diabetic patients.
- Sepsis of Non-urinary Origin: Sepsis from any source can cause altered mental status, which might be described as feeling drunk. The leukocytes in the urine could be a contaminant or a sign of a secondary infection.
- Do Not Miss Diagnoses
- Central Nervous System (CNS) Infection: Infections like meningitis or encephalitis can cause altered mental status and might have a urinary manifestation due to the systemic nature of the infection.
- Sepsis due to a Non-obvious Source: Sepsis from any source (e.g., pneumonia, intra-abdominal infection) can present with non-specific symptoms, including altered mental status and urinary findings.
- Endocarditis: Although less common, endocarditis can present with a wide range of symptoms, including confusion and urinary abnormalities due to embolic phenomena or immune complex deposition.
- Rare Diagnoses
- Porphyria: A group of disorders that can cause neurological symptoms, including altered mental status that might be described as feeling drunk, and could potentially have urinary findings due to the disease process.
- Heavy Metal Poisoning: Certain heavy metals can cause neurological symptoms and might have urinary manifestations. However, this would be an unusual presentation without a clear exposure history.
- Other Metabolic Disorders: Rare metabolic disorders could potentially cause both neurological symptoms and urinary abnormalities, but these would be less common and might require specific diagnostic testing to identify.