Differential Diagnosis for 7-year-old patient with fever, nausea, vomiting, diarrhea, pain while urinating
- Single most likely diagnosis
- Diabetic Ketoacidosis (DKA): The presence of 3+ ketones in the urinalysis without glucose is highly suggestive of DKA, especially in a pediatric patient presenting with symptoms such as fever, nausea, vomiting, and abdominal pain. The pain while urinating could be related to the dehydration and possible urinary tract infection, but the primary concern would be DKA.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): Although the urinalysis shows no leukocytes, UTIs can present with dysuria (pain while urinating) and systemic symptoms like fever and nausea. The absence of leukocytes does not entirely rule out a UTI, especially if the patient is taking antibiotics or has a partially treated infection.
- Gastroenteritis: The combination of fever, nausea, vomiting, and diarrhea could suggest a viral or bacterial gastroenteritis. However, the presence of ketones and the specific symptom of pain while urinating might lean more towards other diagnoses.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although less likely given the specific symptoms, sepsis can present with a wide range of symptoms including fever, nausea, vomiting, and abdominal pain. It's crucial to consider sepsis, especially if the patient's condition deteriorates or if there's a suspicion of a bacterial infection.
- Pyelonephritis: An upper urinary tract infection that can present with similar symptoms to a lower UTI but may also include flank pain and systemic symptoms. It's a serious condition that requires prompt treatment.
- Rare diagnoses
- Urethral stricture or obstruction: Could cause pain while urinating but would be less likely in a pediatric patient without a history of trauma or previous urinary issues.
- Interstitial nephritis: An inflammation of the spaces between the renal tubules, which could cause pain and systemic symptoms, but is less common and might not directly explain all the symptoms presented.