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), suggests DKA, even though there's no prior history of diabetes. The A1C of 7.2% also indicates poor glucose control over the past 2-3 months. The elevated CRP (42.9) could indicate an inflammatory response, which can be seen in DKA.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): The urinalysis showing WBCs (6-10), bacteria, and proteinuria supports this diagnosis. The mild circumferential thickening of the bladder wall on CT could be consistent with cystitis.
- Dehydration: Given the elevated glucose and the presence of ketones, dehydration could be a contributing factor, especially if the patient has been experiencing polyuria due to uncontrolled diabetes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the primary diagnosis seems to be DKA with possible UTI, the elevated WBC count (11.5) and CRP (42.9) could also indicate sepsis, particularly if the UTI has progressed to pyelonephritis or urosepsis. The presence of bacteria in the urine supports this concern.
- Emphysematous Cystitis: Although the CT specifically mentions no air within the bladder wall or bladder, this condition can be life-threatening and should be considered, especially with the patient's presentation of possible UTI and diabetes.
- Rare diagnoses
- Other causes of ketonuria, such as alcoholic ketoacidosis or starvation ketoacidosis, though these would be less likely given the glucose levels and the absence of a mentioned history of alcohol abuse or starvation.
- Interstitial nephritis, which could explain the proteinuria and WBCs in the urine, but would be less likely without other supporting symptoms or exposures (e.g., certain medications).