Differential Diagnosis for 57-year-old Female Patient
Single Most Likely Diagnosis
- Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemic State (HHS) induced by recent medication changes: The patient's recent initiation of Jardiance (empagliflozin) and Rybelsus (oral semaglutide), both of which can increase the risk of DKA, especially in the context of her uncontrolled diabetes and significant drop in blood glucose levels, makes this a highly plausible diagnosis. The symptoms of fatigue, weakness, body aches, and heavy breathing with exertion are consistent with DKA or HHS.
Other Likely Diagnoses
- Viral upper respiratory infection: Given the patient's symptoms of scant clear nasal drainage and the use of over-the-counter Tylenol Cold and flu, a viral upper respiratory infection is a possible diagnosis. However, the severity of her systemic symptoms (fatigue, weakness, heavy breathing) suggests that there might be more to her presentation than a simple viral infection.
- Medication-induced side effects: The recent change in medications could also be causing side effects that mimic her symptoms. For example, SGLT2 inhibitors like Jardiance can cause dehydration and potentially exacerbate symptoms like fatigue and weakness.
- Exacerbation of chronic kidney disease: The patient's chronic kidney disease could be exacerbated by the recent medication changes, particularly the use of SGLT2 inhibitors, which can affect renal function, leading to symptoms like fatigue and weakness.
Do Not Miss Diagnoses
- Pulmonary embolism: Although less likely, given the patient's symptoms of heavy breathing with exertion and her history of hyperlipidemia and hypertension, pulmonary embolism is a diagnosis that cannot be missed due to its high mortality rate if untreated.
- Sepsis: The patient's presentation with systemic symptoms like fatigue, weakness, and body aches, in combination with her chronic medical conditions, raises the concern for sepsis, especially if she has an underlying infection.
- Cardiac ischemia or myocardial infarction: Given her history of hypertension and hyperlipidemia, cardiac ischemia or myocardial infarction must be considered, especially if her symptoms of heavy breathing and fatigue are indicative of decreased cardiac output.
Rare Diagnoses
- Addisonian crisis: Although rare, an Addisonian crisis (adrenal insufficiency) could present with similar symptoms of fatigue, weakness, and body aches, especially if triggered by the stress of her recent medication changes or an underlying infection.
- Thyroid storm: Given her systemic symptoms, a thyroid storm, although rare, could be considered, especially if she has a history of thyroid disease. However, this would typically be accompanied by more specific symptoms like tremors, heat intolerance, and exophthalmos.