Differential Diagnosis
The patient presents with a complex set of symptoms including shakiness, sweating, eye discoloration, dry mouth, lightheadedness, and dizziness, following a recent dose increase of Zepbound. Considering the patient's medication regimen and symptoms, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Zepbound (tirzepatide) side effects: The recent dose increase of Zepbound, a medication known for its potential to cause gastrointestinal side effects, hypoglycemia (in diabetic patients), and other systemic effects, aligns closely with the patient's symptoms. The shakiness and sweating could be indicative of hypoglycemic episodes, even though the patient denies having diabetes, as tirzepatide can increase insulin secretion. The eye discoloration and right upper quadrant pain could suggest liver enzyme elevations or gallbladder pathology, which are known side effects of GLP-1 receptor agonists like tirzepatide.
Other Likely Diagnoses
- Bupropion side effects: The patient's long-term use of bupropion, an antidepressant known to cause dry mouth and potentially contribute to anxiety or tremors, could exacerbate some symptoms.
- Anxiety or panic attacks: The symptoms of shakiness, sweating, and lightheadedness, especially in the context of recent stressors or the use of buspirone for anxiety, could suggest anxiety or panic attacks.
- Dehydration: Despite consuming a lot of water, the patient's dry mouth could indicate dehydration, potentially exacerbated by bupropion or other factors.
Do Not Miss Diagnoses
- Hypoglycemia: Even without a history of diabetes, the patient's symptoms of shakiness and sweating, particularly after meals, could indicate hypoglycemia, a potentially life-threatening condition if not promptly addressed.
- Liver injury or gallbladder disease: Given the patient's history of gallstones and cholecystectomy, and current symptoms of right upper quadrant pain and eye discoloration, liver enzyme elevations or recurrent gallbladder disease must be considered to prevent serious outcomes.
- Medication-induced hepatitis: The eye discoloration (jaundice) and abdominal pain could suggest hepatitis, potentially induced by one of the patient's medications, which is a serious condition requiring immediate medical attention.
Rare Diagnoses
- Pheochromocytoma: Although rare, this condition could cause episodic shakiness, sweating, and lightheadedness, especially if associated with meals or specific activities.
- Thyroid disorders: Hyperthyroidism could cause similar symptoms, including shakiness, sweating, and dry mouth, and should be considered in the differential diagnosis, especially if other signs such as weight loss or exophthalmos are present.