Differential Diagnosis for a 17-year-old female with unknown poisoning
- Single most likely diagnosis:
- Anticholinergic poisoning: This is likely due to the symptoms of dilated pupils, headache, nausea, and abdominal pain, which are consistent with anticholinergic toxicity. Common substances that can cause this include certain medications, plants, and chemicals.
- Other Likely diagnoses:
- Opioid withdrawal: Although less likely given the dilated pupils, opioid withdrawal can cause nausea, abdominal pain, and headache. The normal reacting pupils and the presence of other symptoms make this a consideration.
- Sympathomimetic toxicity: This could be due to substances like amphetamines or cocaine, leading to dilated pupils, increased pulse, and blood pressure, along with headache and abdominal pain.
- Cannabis intoxication: While less likely to cause severe abdominal pain, cannabis can lead to nausea, headache, and altered perception, which might fit some of the symptoms described.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Organophosphate poisoning: Although the symptoms don't perfectly align (one would expect miosis, not mydriasis), the possibility of mixed poisoning or an atypical presentation makes this a "do not miss" diagnosis due to its high mortality if untreated.
- Tricyclic antidepressant (TCA) overdose: TCAs can cause anticholinergic symptoms, including dilated pupils, but they can also lead to cardiac arrhythmias, which would be life-threatening. The blood pressure and pulse readings could be consistent with early TCA toxicity.
- Rare diagnoses:
- Botulism: This would typically present with descending paralysis, starting with cranial nerves, but in very early stages, it might be considered with dilated pupils and gastrointestinal symptoms.
- Mushroom poisoning: Certain mushrooms can cause a variety of symptoms, including gastrointestinal distress, headache, and altered mental status, but the specific pattern can vary widely depending on the mushroom ingested.