Differential Diagnosis for 78-year-old Female with Nausea and Dizziness after Increased Semaglutide Dose

• Single most likely diagnosis:
  • Vertigo: The patient's symptoms of feeling nauseous and "the room spinning" are classic presentations of vertigo, which can be exacerbated or triggered by the increased dose of semaglutide, a medication known to cause gastrointestinal side effects including nausea and potentially contributing to dizziness or vertigo.
• Other Likely diagnoses:
  • Dehydration: Given the recent increase in semaglutide, which can cause nausea and potentially vomiting, dehydration is a plausible cause for her symptoms, including dizziness and low blood pressure (128/60 mmHg).
  • Orthostatic Hypotension: The low diastolic blood pressure (60 mmHg) could indicate orthostatic hypotension, especially if the patient has experienced a drop in blood pressure upon standing, which can cause dizziness or lightheadedness.
  • Gastroenteritis: Although less directly related to the medication increase, a viral or bacterial gastroenteritis could cause similar symptoms of nausea and dizziness.
• Do Not Miss diagnoses:
  • Stroke or Transient Ischemic Attack (TIA): Although less likely given the context, it's crucial not to miss a stroke or TIA, as these conditions can present with sudden onset of dizziness or vertigo and require immediate medical attention.
  • Cardiac Arrhythmias: Certain arrhythmias can cause dizziness or lightheadedness and may be detected on the EKG. Given the patient's age, it's essential to consider cardiac causes for her symptoms.
  • Hypoglycemia: Semaglutide can affect glucose metabolism. Although the patient's symptoms do not classically suggest hypoglycemia, it's a critical condition to rule out, especially in diabetic patients or those on medications that can lower blood sugar.
• Rare diagnoses:
  • Vestibular Migraine: This condition can cause vertigo and is often accompanied by other migraine symptoms, but it's less likely given the acute onset in relation to medication change.
  • Inner Ear Disorders (e.g., labyrinthitis, benign paroxysmal positional vertigo): While possible, these are less directly related to the recent increase in semaglutide and would require further specific symptoms or diagnostic findings to support.
  • Adverse Drug Reaction (beyond common side effects): Although semaglutide's common side effects include nausea, a more severe or idiosyncratic reaction could potentially cause the patient's symptoms, but this would be less common.