Differential Diagnosis for Op Poisoning with Altered Sensorium

Single Most Likely Diagnosis

• Opioid Overdose: This is the most likely diagnosis given the presentation of op poisoning and altered sensorium. Opioids are known to cause respiratory depression, altered mental status, and can lead to coma or death if not treated promptly.

Other Likely Diagnoses

• Benzodiazepine Overdose: Benzodiazepines can also cause altered sensorium and when combined with opioids, the effects can be synergistic, leading to severe respiratory depression and altered mental status.
• Alcohol Intoxication: Alcohol can cause altered sensorium and when combined with opioids, can exacerbate the effects, leading to increased risk of respiratory depression and death.
• Gamma-Hydroxybutyric Acid (GHB) Overdose: GHB is a central nervous system depressant that can cause altered sensorium, respiratory depression, and coma, similar to opioids.

Do Not Miss Diagnoses

• Traumatic Brain Injury: In the context of altered sensorium, it's crucial not to miss a traumatic brain injury, which could be the cause or result of the poisoning. Missing this diagnosis could lead to delayed treatment and poor outcomes.
• Infection (e.g., Meningitis, Encephalitis): Infections such as meningitis or encephalitis can present with altered sensorium and must be considered, especially if there are signs of infection or a compromised immune system.
• Hypoglycemia: Hypoglycemia can cause altered mental status and is easily treatable. Missing this diagnosis could lead to prolonged brain injury or death.
• Hyperthermia/Hypothermia: Both hyperthermia and hypothermia can cause altered sensorium. Environmental exposure or drug-induced temperature dysregulation should be considered.

Rare Diagnoses

• Recreational Drug Overdose (e.g., Ketamine, PCP): While less common, overdoses on recreational drugs like ketamine or PCP can cause altered sensorium and should be considered, especially in the appropriate clinical context.
• Toxic Ingestions (e.g., Anticholinergics, Serotonin Syndrome): Certain toxic ingestions can cause altered mental status. Although rare, they are critical to diagnose due to the potential for specific antidotes or treatments.
• Endocrine Disorders (e.g., Myxedema Coma, Adrenal Crisis): Endocrine emergencies such as myxedema coma or adrenal crisis can present with altered sensorium. These are rare but critical diagnoses that require prompt recognition and treatment.