Differential Diagnosis
- Single most likely diagnosis
- Diabetic Ketoacidosis (DKA): The patient's glucose level is elevated at 200, with a corresponding glucose level in the urine of 250 and the presence of ketones in the urine (15). These findings, along with the patient's leukocytosis (WBC 11.5) and the absence of other clear causes for the elevated WBC, suggest an infection or a metabolic derangement such as DKA. The presence of protein in the urine could be related to the diabetic state.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): The urinalysis shows WBCs (6-10), bacteria (few), and protein (100), which are indicative of a UTI. The mild circumferential thickening of the bladder wall seen on the CT pelvis could also be consistent with a UTI or cystitis.
- Dehydration: The patient's hematocrit is slightly elevated at 46.7%, which could indicate dehydration, a common finding in patients with DKA or those who are not adequately hydrated.
- Do Not Miss (ddxs that may not be deadly if missed but are critical to consider)
- Sepsis: Although the patient's WBC count is elevated, which could be due to several reasons including infection or metabolic stress, it's crucial to consider sepsis, especially if the patient shows signs of infection (like the UTI suggested by the urinalysis) and systemic response.
- Acute Kidney Injury (AKI): The presence of granular casts in the urine (0-2) could indicate renal involvement or injury, which is a critical condition to identify and manage promptly.
- Rare diagnoses
- Emphysematous Cystitis: Although the CT pelvis specifically mentions no air within the bladder wall or bladder, this condition is a rare but serious infection of the bladder where gas is produced in the bladder wall or lumen. The mild thickening of the bladder wall and the presence of bacteria and WBCs in the urine make it worth considering, despite the CT findings.
- Other metabolic disorders: While DKA is the most likely metabolic derangement given the glucose and ketone levels, other metabolic disorders could potentially present with similar lab findings and should be considered if the patient's condition does not improve with DKA management or if other specific symptoms or lab findings suggest an alternative diagnosis.