Differential Diagnosis for Postpartum Patient with Nausea and Lightheadedness
- Single most likely diagnosis:
- Hypovolemic shock due to postpartum hemorrhage (PPH) or significant blood loss during surgery. The patient's symptoms of nausea, lightheadedness, fatigue, low blood pressure (80/50 mm Hg), tachycardia (124/min), and pale, cold skin are consistent with hypovolemic shock. Although the uterine fundus is firm and there's minimal lochia, internal bleeding or bleeding not visible externally could still be occurring.
- Other Likely diagnoses:
- Dehydration: The patient is on NSAIDs for pain, which could contribute to dehydration, especially if she's not drinking enough fluids. Dehydration can cause similar symptoms to hypovolemic shock, including dizziness and fatigue.
- Postpartum infection or sepsis: Although the patient's abdomen is tender, the absence of increased bleeding or fever doesn't strongly support this diagnosis. However, it's still a possibility, especially if the infection is early or localized.
- Post-dural puncture headache (if regional anesthesia was used during the cesarean delivery): This could cause nausea, lightheadedness, and fatigue, but typically presents with a severe headache.
- Do Not Miss diagnoses:
- Pulmonary embolism: Although less likely given the clinical presentation, pulmonary embolism is a potentially deadly condition that can occur postpartum, especially after surgery. Symptoms can include sudden onset of shortness of breath, chest pain, and tachycardia, but can sometimes present more subtly.
- Amniotic fluid embolism: Another rare but potentially fatal condition that can occur during or after delivery. Symptoms can include sudden onset of hypotension, hypoxia, and either cardiac arrest or coagulopathy.
- Uterine rupture or inversion: These are rare complications of cesarean delivery that can cause severe bleeding and shock. The firm uterine fundus makes rupture less likely, but inversion could still be a consideration if there were symptoms of severe abdominal pain and bleeding.
- Rare diagnoses:
- Adrenal insufficiency: Could present with hypotension, fatigue, and nausea, but would be unusual in this context without a history of adrenal disease.
- Cardiac complications (e.g., myocardial infarction, cardiomyopathy): These are rare in young, otherwise healthy women but could present with similar symptoms. A thorough cardiac history and possibly further testing might be warranted if other causes are ruled out.