Differential Diagnosis for Severe Vomiting with Lactic Acidosis
Single Most Likely Diagnosis
- Diabetic Ketoacidosis (DKA): This condition is characterized by hyperglycemia, metabolic acidosis, and ketosis. Severe vomiting can be a presenting symptom, and lactic acidosis can occur due to tissue hypoperfusion and increased lactate production. The combination of hyperglycemia, ketosis, and metabolic acidosis makes DKA a likely diagnosis.
Other Likely Diagnoses
- Gastroenteritis: Severe vomiting can lead to dehydration, which may cause lactic acidosis due to decreased perfusion of tissues. Certain infections can also directly cause lactic acidosis.
- Pancreatitis: Acute pancreatitis can cause severe vomiting and abdominal pain. Lactic acidosis may occur due to hypovolemia, hypoperfusion, or the release of inflammatory mediators.
- Septic Shock: Severe infection can lead to septic shock, characterized by hypotension, organ dysfunction, and lactic acidosis. Vomiting can be a symptom of the underlying infection or a consequence of the systemic inflammatory response.
Do Not Miss Diagnoses
- Methanol or Ethylene Glycol Poisoning: These toxic ingestions can cause severe metabolic acidosis, including lactic acidosis, and vomiting. Early recognition is crucial for treatment with antidotes and dialysis.
- Salicylate Toxicity: Aspirin overdose can lead to severe metabolic acidosis, vomiting, and lactic acidosis. It requires prompt recognition and treatment with bicarbonate and potential dialysis.
- Malignant Ovarian Hyperthermia: Although rare, this condition can cause severe vomiting, lactic acidosis, and hyperthermia in the setting of ovarian tumors.
Rare Diagnoses
- Mitochondrial Disorders: Certain mitochondrial myopathies can cause lactic acidosis, especially during periods of increased energy demand or fasting. Vomiting may be a symptom of the underlying disorder.
- D-Lactic Acidosis: This condition occurs in patients with short bowel syndrome who have an overgrowth of D-lactate-producing bacteria in their gut. It can cause severe metabolic acidosis and vomiting.
- Pyruvate Dehydrogenase Deficiency: A rare genetic disorder that affects the metabolism of pyruvate, leading to lactic acidosis. Vomiting can be a presenting symptom, especially during episodes of acute illness or fasting.