Differential Diagnosis for Patient on Wegovy with Ketones and Bilirubin in Urine

Single Most Likely Diagnosis

• Diabetic Ketoacidosis (DKA): This condition is a complication of diabetes characterized by the presence of ketones in the urine, which can occur in patients taking medications like Wegovy (semaglutide), especially if they have diabetes or are at risk for it. The presence of ketones in the urine is a hallmark of DKA.

Other Likely Diagnoses

• Dehydration: Patients on Wegovy may experience nausea, vomiting, or diarrhea, leading to dehydration. Dehydration can cause a concentration of bilirubin in the urine, giving a false-positive result for bilirubinuria. Additionally, dehydration can exacerbate conditions leading to ketosis.
• Gallbladder Disease: Since Wegovy can affect gallbladder function and increase the risk of gallstones, it's possible that the bilirubin in the urine could be related to a gallbladder issue, such as a stone obstructing the common bile duct, leading to conjugated hyperbilirubinemia.
• Medication-Induced Liver Injury: Although less common, some medications, including those in the same class as Wegovy, can cause liver injury, which might result in elevated bilirubin levels.

Do Not Miss Diagnoses

• Acute Pancreatitis: This is a serious condition that can be associated with medications like Wegovy. While pancreatitis itself might not directly cause ketones and bilirubin in the urine, it's a critical diagnosis to consider due to its potential severity and the fact that pancreatitis can lead to secondary complications that might result in these findings.
• Hemolytic Anemia: Although less likely, conditions causing hemolysis (breakdown of red blood cells) could lead to elevated bilirubin in the urine. This would be a critical diagnosis not to miss due to its potential for severe outcomes if left untreated.

Rare Diagnoses

• Primary Biliary Cholangitis or Other Chronic Liver Diseases: These conditions could lead to elevated bilirubin in the urine but would be less directly related to the use of Wegovy and the presence of ketones.
• Starvation Ketosis: In rare cases, significant caloric restriction (which could be exacerbated by the appetite-suppressing effects of Wegovy) could lead to ketosis without the context of diabetes or DKA. However, this would be less likely to present with bilirubin in the urine.