Differential Diagnosis for the 22-year-old Woman
- Single most likely diagnosis
- Magnesium toxicity: The patient is receiving a magnesium sulfate infusion, and the absence of patellar reflexes is a key indicator of magnesium toxicity. The somnolence and minimal urine output also support this diagnosis, as magnesium sulfate can cause respiratory depression and urinary retention.
- Other Likely diagnoses
- Hypovolemic shock: Although the patient's blood pressure is currently within a relatively normal range, the significant blood loss during delivery could lead to hypovolemia, contributing to her somnolence and decreased urine output.
- Hyperglycemia: The patient's elevated blood glucose level could contribute to her somnolence, although it is less likely to be the primary cause of her symptoms.
- Postpartum hemorrhage (PPH) complications: The patient's recent history of significant blood loss and the potential for ongoing bleeding could lead to hypovolemic shock, contributing to her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic shock: Although the patient's temperature is only slightly elevated, the possibility of infection, especially in the postpartum period and with a history of significant blood loss, must be considered. Sepsis can rapidly progress to septic shock, which is life-threatening.
- Pulmonary embolism: Given the patient's recent surgery and history of significant blood loss, she is at increased risk for venous thromboembolism, including pulmonary embolism, which can present with sudden onset of symptoms including respiratory distress and altered mental status.
- Stroke: The patient's history of preeclampsia with severe features increases her risk for stroke, which could present with sudden onset of symptoms including somnolence and altered mental status.
- Rare diagnoses
- Wernicke's encephalopathy: Although rare, Wernicke's encephalopathy can occur in patients with a history of malnutrition or those who have undergone significant stress, such as postpartum hemorrhage. It presents with altered mental status, ophthalmoplegia, and ataxia.
- Adrenal insufficiency: The patient's history of significant stress and potential for adrenal insufficiency, especially in the context of her type 1 diabetes mellitus, could contribute to her symptoms, although it is less likely.