Differential Diagnosis for Low Total Protein, Albumin, and Globulin with Vomiting Symptom

Single Most Likely Diagnosis

• Gastroenteritis: This condition often leads to vomiting, which can cause dehydration and electrolyte imbalances. The loss of fluids and electrolytes can result in a decrease in total protein, albumin, and globulin levels due to hemodilution and decreased synthesis.

Other Likely Diagnoses

• Nephrotic Syndrome: Characterized by heavy proteinuria, hypoalbuminemia, and edema. While vomiting is not a primary symptom, it can occur due to associated conditions like dehydration or electrolyte imbalances. The low albumin and globulin levels are consistent with this diagnosis.
• Liver Disease (Cirrhosis): Liver dysfunction can lead to decreased synthesis of proteins, including albumin and globulin, resulting in low levels. Vomiting can occur due to various complications of liver disease, such as hepatic encephalopathy or gastrointestinal bleeding.
• Malnutrition: Prolonged vomiting can lead to malnutrition, which affects the body's ability to synthesize proteins, resulting in low total protein, albumin, and globulin levels.

Do Not Miss Diagnoses

• Addison's Disease: Although rare, this condition can present with vomiting, dehydration, and electrolyte imbalances. The adrenal insufficiency can lead to changes in protein levels, making it crucial not to miss this diagnosis due to its potential severity.
• Diabetic Ketoacidosis (DKA): DKA can cause vomiting, dehydration, and electrolyte disturbances. While the primary issue in DKA is glucose and electrolyte imbalance, the severe metabolic derangement can indirectly affect protein levels.

Rare Diagnoses

• Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, which can lead to organ dysfunction, including liver and kidney problems. Vomiting can be a symptom, and protein levels can be affected due to organ involvement.
• Multiple Myeloma: A plasma cell disorder that can lead to an overproduction of a specific type of globulin, but in some cases, it might present with a decrease in other protein levels due to kidney damage or other complications. Vomiting is not a primary symptom but can occur due to hypercalcemia or other associated conditions.