Differential Diagnosis for 74F with N&V and Syncope
- Single Most Likely Diagnosis
- Dehydration and electrolyte imbalance secondary to severe vomiting: The patient's symptoms of nausea, vomiting, and inability to keep food or water down, along with dry mucous membranes and orthostatic hypotension (lying BP 102/70, standing BP 86/64), strongly suggest dehydration. The improvement with IV fluids and ondansetron further supports this diagnosis.
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD) exacerbation: The patient's history of reflux and current symptoms of burping and worsened reflux suggest an exacerbation of GERD, which could be contributing to her nausea and vomiting.
- Medication side effects: The patient is on multiple medications, including omeprazole, candesartan, doxazosin, bendroflumethiazide, atorvastatin, and hydroxychloroquine. Any of these could potentially contribute to her symptoms, either through side effects or interactions.
- Acute kidney injury (AKI): The patient's elevated creatinine (284) and AKI stage 3 indicate renal impairment, which could be contributing to her symptoms and dehydration.
- Do Not Miss Diagnoses
- Cardiac causes of syncope: Although the ECG shows sinus rhythm with ectopic beats, cardiac causes of syncope, such as arrhythmias or cardiac ischemia, must be considered, especially given the patient's age and history of hypertension.
- Infection or sepsis: The patient's elevated CRP (49.4) and WCC (11.8) suggest an inflammatory response, which could indicate an underlying infection or sepsis.
- Bleeding or gastrointestinal obstruction: Although the patient reported no blood in her stool, a gastrointestinal bleed or obstruction could still be present and contributing to her symptoms.
- Rare Diagnoses
- Adrenal insufficiency: The patient's symptoms of orthostatic hypotension, weakness, and dehydration could be suggestive of adrenal insufficiency, although this would be a less common diagnosis.
- Pheochromocytoma: The patient's history of hypertension and current symptoms of orthostatic hypotension and tachycardia could be suggestive of a pheochromocytoma, although this is a rare diagnosis.