Differential Diagnosis for a 15-year-old Female with Autism

The patient presents with significant symptoms that require immediate attention. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Dehydration and possible acute gastritis or gastrointestinal obstruction: Given the patient's history of not eating for days and vomiting, dehydration is a likely cause of her current state. The hunched-over posture could indicate abdominal pain, suggesting gastritis or an obstruction.

• Other Likely Diagnoses

  • Constipation: Individuals with autism may have gastrointestinal issues, including constipation, which could lead to abdominal pain and vomiting.
  • Gastroesophageal reflux disease (GERD): This condition can cause significant discomfort, leading to decreased food intake and vomiting.
  • Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis could present with similar symptoms, especially in a patient who has not been eating.

• Do Not Miss Diagnoses

  • Appendicitis: Although less common, appendicitis can present with vomiting and abdominal pain. It's crucial to consider this diagnosis due to its potential for severe complications if not promptly treated.
  • Intestinal obstruction: This is a medical emergency that requires immediate intervention. Symptoms can include severe abdominal pain, vomiting, and constipation.
  • Eating disorder: Given the patient's history of not eating for days, an eating disorder should be considered, especially in adolescents. This condition has significant psychological and physical implications.

• Rare Diagnoses

  • Mitochondrial disorders: Some mitochondrial disorders can present with gastrointestinal symptoms, including vomiting and abdominal pain, especially after periods of fasting or poor nutrition.
  • Porphyrias: This group of disorders can cause acute abdominal pain, vomiting, and neurological symptoms. They are rare but important to consider in cases where the diagnosis is unclear.

Initial Orders

Given the patient's presentation, initial orders should focus on stabilizing the patient, managing symptoms, and further investigating the cause of her condition. These may include:

• Intravenous fluids for rehydration
• Electrolyte panel to assess for imbalances
• Complete blood count (CBC) to evaluate for infection or inflammation
• Blood glucose to rule out hypoglycemia
• Abdominal X-rays or ultrasound to evaluate for obstruction or other gastrointestinal issues
• Consideration for a psychiatric evaluation to assess for eating disorders or other mental health concerns

It's essential to approach this patient with a comprehensive mindset, considering both the physical and psychological aspects of her presentation.