Differential Diagnosis
- Single Most Likely Diagnosis
- Diabetes Mellitus: The presence of glucose in the urine (>500) and elevated blood glucose (269) strongly suggests diabetes mellitus. The patient's enlarged, fatty liver is also consistent with this diagnosis, as insulin resistance and diabetes can lead to non-alcoholic fatty liver disease.
- Other Likely Diagnoses
- Urinary Tract Infection (UTI): Although the CT scan did not show any urinary tract stones, the presence of blood, WBCs, RBCs, and bacteria in the urine suggests a possible UTI. The patient's diabetes also increases their risk of developing a UTI.
- Dehydration: The elevated BUN/creatinine ratio (30.7) may indicate dehydration, which is a common complication of diabetes, especially if the patient is not managing their condition properly.
- Do Not Miss Diagnoses
- Sepsis: Although the CBC is unremarkable, the presence of bacteria in the urine and the patient's diabetes increase their risk of developing sepsis. Sepsis is a life-threatening condition that requires prompt recognition and treatment.
- Pyonephrosis: The presence of bacteria, WBCs, and RBCs in the urine, along with the patient's diabetes, increases the risk of pyonephrosis, a serious infection of the kidney that can be life-threatening if not treated promptly.
- Rare Diagnoses
- Renal Tubular Acidosis: The presence of glucose in the urine and the elevated BUN/creatinine ratio may suggest renal tubular acidosis, a rare condition characterized by impaired renal acidification.
- Glucosuria due to other causes: Although diabetes is the most likely cause of glucosuria, other rare conditions such as renal glyaporationing, Fanconi syndrome, or cystic fibrosis can also cause glucose to appear in the urine.