Differential Diagnosis
- Single most likely diagnosis
- Diabetic Ketoacidosis (DKA): The presence of high glucose levels in both blood (200) and urine (250), along with ketones in the urine (15), strongly suggests DKA, even though there's no history of diabetes. The patient's symptoms and lab results are consistent with this diagnosis.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): The urinalysis shows the presence of bacteria, WBCs (6-10), and protein (100), which are indicative of a UTI. The mild circumferential thickening of the bladder wall on the CT scan also supports this diagnosis.
- Dehydration: The elevated hematocrit (46.7) and the presence of granular casts in the urine suggest dehydration, which could be contributing to the patient's condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the WBC count is elevated (11.5), the presence of bacteria in the urine and the patient's overall condition warrant consideration of sepsis, especially if the patient shows signs of systemic infection.
- Emphysematous Cystitis: Although the CT scan does not show air within the bladder wall, this condition can be life-threatening and should be considered, especially in the context of diabetes (even if not previously diagnosed) and urinary tract infection.
- Rare diagnoses
- Hyperosmolar Hyperglycemic State (HHS): This is a rare condition that can occur in patients with diabetes, characterized by extremely high blood glucose levels and dehydration. Although the glucose level is not extremely high in this case, it's a possibility to consider, especially if the patient's condition worsens.
- Interstitial Nephritis: The presence of granular casts and protein in the urine could suggest interstitial nephritis, although this would be less likely given the other findings.