Differential Diagnosis
- Single most likely diagnosis
- E. Opioid withdrawal: The patient's symptoms of profound fatigue, hunger, vivid nightmares, and poor mood, combined with a history of using multiple substances and recent use before admission, are consistent with opioid withdrawal. The physical exam finding of numerous dental caries also supports this diagnosis, as opioid use is often associated with poor dental health due to neglect and dry mouth.
- Other Likely diagnoses
- C. Amphetamine withdrawal: The symptoms of fatigue, vivid nightmares, and poor mood could also be seen in amphetamine withdrawal. However, amphetamine withdrawal typically presents with more prominent symptoms of depression, anxiety, and insomnia.
- B. Alcohol withdrawal: While alcohol withdrawal can cause fatigue, poor mood, and vivid dreams, it typically presents with more prominent symptoms of tremors, seizures, and hallucinations, which are not mentioned in the scenario.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Benzodiazepine withdrawal: Although less likely, benzodiazepine withdrawal can be life-threatening due to the risk of seizures and delirium. The patient's history of using multiple substances increases the risk of benzodiazepine use, and withdrawal should be considered.
- Rare diagnoses
- A. Nicotine withdrawal: Nicotine withdrawal typically presents with symptoms of irritability, anxiety, and cravings, which are not prominent in this scenario. While possible, it is less likely given the patient's symptoms and history. Note: The patient's symptoms and history are most consistent with opioid withdrawal, but it is essential to consider other potential diagnoses, especially those that could be life-threatening if missed.