What is the diagnosis for a patient with hyponatremia (sodium level of 135), hyperglycemia (glucose level of 200), hypochloremia (chloride level of 97), mildly elevated total bilirubin (1.8), leukocytosis (white blood cell count of 11.5), normal hematocrit (46.7), absolute neutrophil count of 1.1, glycosuria (urine glucose of 250), ketonuria (urine ketones of 15), proteinuria (urine protein of 100), pyuria (urine white blood cell count of 6-10), and bacteriuria, with a history of hypertension (high blood pressure) and no history of diabetes, and imaging showing mild circumferential thickening of the bladder wall?

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Last updated: April 14, 2025 • View editorial policy

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, which could indicate a UTI. The mild circumferential thickening of the bladder wall seen on the CT scan also supports this possibility. + 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 absolute neutrophil count is low (1.1), which could indicate a severe infection. The presence of bacteria in the urine and the patient's overall condition make sepsis a possibility that should not be missed. + Emphysematous Cystitis: The CT scan shows mild thickening of the bladder wall, but no air is seen within the bladder wall or lumen. However, this condition can be life-threatening and should be considered, especially given the patient's symptoms and lab results.
  • Rare diagnoses + Hyperosmolar Hyperglycemic State (HHS): Although less likely than DKA, HHS is a possibility, especially given the high glucose levels. However, the presence of ketones in the urine makes DKA more likely. + Interstitial Nephritis: The presence of granular casts and protein in the urine could suggest interstitial nephritis, but this diagnosis is less likely given the patient's overall presentation.

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