What is the differential diagnosis for a patient with hypotension, impaired renal function, and refusal to eat or drink, who is currently taking Eliquis (apixaban) and Motrin (ibuprofen) 10mg every eight hours, and has a history of hemodialysis and ostomy site bleeding?

Differential Diagnosis

The patient presents with hypotension, refusal to eat or drink, and a history of recent hemodialysis. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Hypovolemia: The patient's very low blood pressure (66/37), refusal to eat or drink for 24 hours, and 1200 cc fluid restriction suggest hypovolemia as the most likely cause of his symptoms. The patient's recent hemodialysis may have also contributed to fluid loss.
• Other Likely diagnoses
  • Sepsis: Although the patient is afebrile, his recent hospitalization, IV antibiotic use, and current hypotension raise the possibility of sepsis. The patient's refusal to eat or drink may be a sign of systemic illness.
  • Adverse reaction to medication: The patient is taking Eliquis (an anticoagulant) and Motrin (an NSAID), which can increase the risk of bleeding. The superficial bleeding at the ostomy site and hypotension may be related to an adverse reaction to one of these medications.
  • Hemorrhage: The patient's history of superficial bleeding at the ostomy site and current hypotension raise the possibility of ongoing hemorrhage.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cardiac tamponade: Although the patient's heart is regular, cardiac tamponade can present with hypotension and is a life-threatening condition that requires prompt diagnosis and treatment.
  • Pulmonary embolism: The patient's recent hospitalization and immobility increase his risk of pulmonary embolism, which can present with hypotension and is a life-threatening condition.
  • Septic shock: Although the patient is afebrile, septic shock can present with hypotension and is a life-threatening condition that requires prompt diagnosis and treatment.
• Rare diagnoses
  • Adrenal insufficiency: The patient's hypotension and refusal to eat or drink may be signs of adrenal insufficiency, although this is a rare condition.
  • Pheochromocytoma: The patient's hypotension and recent hemodialysis may be related to a pheochromocytoma, although this is a rare condition.