Differential Diagnosis for Haemodialysis Patient
Single most likely diagnosis
- Sepsis: The patient's presentation with cough, chest pain, and initial treatment with oral antibiotics, followed by worsening symptoms including hypotension, abdominal pain, and a high CRP level, suggests a severe infection. The patient's failure to respond to adrenaline indicates severe sepsis or septic shock, which is a life-threatening condition.
Other Likely diagnoses
- Pneumonia: Given the initial symptoms of cough and chest pain, pneumonia is a likely diagnosis, especially if the patient's condition has progressed to sepsis.
- Peritonitis: Abdominal pain and high CRP in a haemodialysis patient could suggest peritonitis, especially if the patient is on peritoneal dialysis.
- Cardiac complications: Haemodialysis patients are at high risk of cardiac complications, including myocardial infarction or cardiac tamponade, which could present with chest pain and hypotension.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although less likely, pulmonary embolism is a potentially life-threatening condition that could present with sudden onset of chest pain and hypotension.
- Aortic dissection: This is a rare but deadly condition that could present with severe chest pain and hypotension, especially in patients with underlying cardiovascular disease.
- Bleeding complication: Haemodialysis patients are at risk of bleeding complications, including gastrointestinal bleeding, which could present with abdominal pain and hypotension.
Rare diagnoses
- Tuberculosis: Although rare, tuberculosis could present with chronic cough and chest pain, and should be considered in patients with risk factors.
- Fungal infection: Haemodialysis patients are at risk of fungal infections, including invasive aspergillosis, which could present with similar symptoms.
- Haemodialysis-related complications: Rare complications related to haemodialysis, such as dialyser reaction or air embolism, should also be considered.