Differential Diagnosis for Maribel
- Single Most Likely Diagnosis
- Intentional overdose with mixed prescription medications: This is the most likely diagnosis given Maribel's history of taking at least a week's worth of her prescription medications, including propranolol, sertraline, levothyroxine, haloperidol/risperidone, benztropine, and atorvastatin, which led to her altered mental status and hospital admission.
- Other Likely Diagnoses
- Hypothyroidism exacerbation: Maribel's elevated TSH level (23.66) indicates hypothyroidism, which could be contributing to her altered mental status and other symptoms.
- Psychiatric decompensation: Given Maribel's history of schizophrenia, depression, psychosis, insomnia, and anxiety, it is possible that she experienced a psychiatric decompensation, which may have contributed to her intentional overdose.
- Electrolyte imbalance: Maribel's low magnesium level (1.5) could be contributing to her symptoms, including altered mental status and cardiac arrhythmias.
- Do Not Miss Diagnoses
- Serotonin syndrome: Although Maribel's UA/UDS was negative, and she was taking sertraline, which can cause serotonin syndrome, especially when combined with other medications, this diagnosis should not be missed due to its potential severity.
- Neuroleptic malignant syndrome (NMS): Given Maribel's use of haloperidol/risperidone, NMS is a possible diagnosis that should not be missed, as it can be life-threatening.
- Cardiac complications: Although Maribel's EKG showed sinus tachycardia without significant QTc prolongation, cardiac complications, such as arrhythmias or cardiac arrest, can occur with overdose, especially with medications like propranolol and atorvastatin.
- Rare Diagnoses
- Thyroid storm: Although Maribel's TSH level is elevated, indicating hypothyroidism, a thyroid storm is a rare but possible diagnosis, especially if she has underlying thyroid disease.
- Atorvastatin-induced rhabdomyolysis: Although rare, atorvastatin can cause rhabdomyolysis, especially when combined with other medications or in the setting of overdose.