Sandbox: wdx causes
Differential Diagnosis
Abbreviations: ABG = Arterial blood gases, BUN = Blood urea nitrogen, CBC = Complete blood count, CT = Computed tomography, CRP = C - reactive protein, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, IVP = Intravenous pyelography, KFT = Kidney function test, GI = Gastrointestinal, GFR = Glomerular filtration rate, MRI = Magnetic resonance imaging, PT = Prothrombin time
| Etiology | Clinical manifestations | Paraclinical findings | Comments | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms and signs | Lab findings | Imaging | ||||||||||||||||||||
| Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | |||
| Prerenal causes | Alcohol poisoning | + | + | +/- | - | +/- | + | +/- | - | - | ↑PT | ↑BUN, ↑Cr (isopropyl alcohol) | ↓Na | NA | ↓HCO3 | LFT | NA | NA | NA | NA | - | Thiamine must be given to prevent Wernicke's encephalopathy |
| Aspergillosis | +/- | - | - | - | - | - | - | +/- | - | NA | NA | NA | NA | NA | Allergy test, ↑IgE (>1000 IU/dl), Direct visualization of fungal hyphae | NA | Pulmonary infiltrates, Mucus plug, Mass in the upper lobe surrounded by a crescent of air, Solitary or multiple cavities | Halo sign, Wedge-shaped pulmonary infarction, Granuloma | NA | - | Polymerase chain reaction (PCR) | |
| Cholera[1] | +/- | + | - | - | - | +/- | + | - | - | Leukocytosis, ↑HCT | ↑BUN, ↑Cr | ↓Na, ↑Ca, ↑Mg | NA | ↑Lactate, ↓HCO3 | Stool PCR, Stool culture, Serotyping | NA | NA | NA | NA | - | - | |
| Congestive heart failure (CHF) | + | - | - | - | - | - | + | - | + | Anemia, Leukocytosis | ↑BUN, ↑Cr | ↓Na, ↑K | NA | ↑Lactate, ↓HCO3, | ↑BNP, ↑Troponin | Cardiomegaly, Pulmonary hypertension, Pleural effusions | Pulmonary edema | NA | Valvular heart disease | Decreased ejection fraction in echocardiography, Heart function and damage in nuclear imaging | - | |
| Dehydration | + | + | - | +/- | - | +/- | +/- | - | - | NA | ↑BUN, ↑Cr | ↓Na, ↑K, ↓Cl | Ketones and glucose, ↑Urine specific gravity | ↑Lactate, ↓HCO3 | Hypoglycemia | NA | NA | NA | NA | - | - | |
| Diarrhea and/or vomiting | +/- | +/- | - | - | - | + | + | - | - | Leukocytosis with predominant neutrophilia, ↑ ESR | NA | NA | Ketones, Organic acids, Porphobilinogen, Aminolevulinic acid | NA | Stool anion gap, Stool pH < 5.5, Stool culture, Serotyping, Enzyme immunoassay (rotavirus or adenovirus), LFT, Amylase, Lipase | Normal | NA | NA | NA | - | - | |
| Drugs/toxins | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | NA | ↑BUN, ↑Cr, ↑CK | ↑K, ↓Mg, ↓Ca, ↓P | Ingested drug, Glucose, Aminoacid, Phosphate, Ketone, Hyaline cast, RBC | ↑Lactate, Metabolic acidosis | Toxicology, Rapid immunoassay | Nephropathy | Radioopaque substances, Ingested drug packets | NA | NA | - | - | |
| Esophageal varices bleeding | +/- | - | - | - | +/- | - | - | - | - | Normocytic normochromic anemia | ↑BUN, ↑Cr | NA | NA | NA | NA | Velocity and direction of portal flow | Abnormal opacities outside ofesophageal wall, Posterior mediastinal or intraparenchymal mass, Dilated azygous vein | Entire portal venous system | Portrays esophageal varices as flow voids | Portal hypertension and esophageal varices in positron emission tomography, Flexible endoscope, Barium swallow of snake-like filling defects | - | |
| Heart disease | +/- | - | - | - | - | - | - | +/- | +/- | ↑ESR and CRP | ↑BUN, ↑Cr | NA | NA | NA | Throat culture, Rapid streptococcal antigen test, Hyperoxia test, Pulse oximetry | NA | Cardiomegaly, Dextrocardia | NA | NA | Ventricular dysfunction, Left and right ventricular hypertrophy, Valvular disease in echocardiography | - | |
| Hemorrhage | - | - | - | - | - | - | - | - | - | Normocytic normochromic anemia, ↑PT, ↑PTT | ↑BUN, ↑Cr | ↑Na, ↑Cl, ↓Ca | NA | Metabolic acidosis | NA | Peritoneal cavity fluid in FAST | Bilateral opacities in the lung field, Hemothorax, Hemoperitoneum, Ruptured abdominal aortic aneurysm | Intrathoracic, intra-abdominal, and retroperitoneal bleeding | NA | Source of bleeding in the upper GI in EGD, Angiography | - | |
| Hemolysis | +/- | - | - | - | - | - | - | - | - | Thrombocytopenia, Microcytic hypochromic anemia, ↑RDW, ↑Retic count | NA | NA | NA | NA | ↑LDH, ↓Haptoglobin, ↑Unconjugated bilirubin | Hepatomegaly,Splenomegaly | NA | NA | NA | - | - | |
| Etiology | Fatigue/
Lethargy |
Thirst | Dizziness/
Confusion |
Muscle weakness/
cramp |
Somatic/
visceral pain |
Vomiting | Diarrhea | Tachypnea | Edema | Blood indices | Renal Funtion test | Electrolytes | Urine analysis | ABG | Other | Ultrasound | X-ray | CT | MRI | Other | Comments | |
| Hepatorenal syndrome | +/- | - | - | - | +/- | +/- | - | - | +/- | Leukocytosis, ↑PT | ↓GFR, ↑BUN, ↑Cr | ↓Na | Proteinuria, Na < 10 mEq/L, Urine osmolality > plasma osmolality | NA | Alpha feto-protein, Cryoglobulinemia | Exclude hydronephrosis and intrinsic renal disease | NA | NA | NA | Right ventricular preload, ventricular filling pressures, and cardiac function in echocardiography | - | |
| Ischemic cardiomyopathy | +/- | - | - | - | - | - | - | +/- | +/- | Anemia | ↑Cr | ↓Na, ↓K, ↓Mg | NA | NA | Troponin, Creatine kinase, Creatine kinase - MB, BNP | NA | Abnormal cardiac silhouette | Biventricular volume, Wall motion abnormality, Myocardial perfusion, Hypertrophic cardiomyopathy | Mid-wall fibrosis in MRI | Ejection fraction ≤35%, Pulmonary embolism, Right ventricular dilation or pericardial effusion with tamponade in echocardiography | - | |
| Liver cirrhosis | +/- | - | +/- | +/- | +/- | - | - | - | +/- | NA | NA | NA | NA | NA | LFT, Aspartate aminotransferase to platelet ratio, FibroTest/FibroSure, Hepascore, FibroSpectatio | Portal blood flow velocity, Hepatic artery enlargement, Multifocal lesions or masses, Hepatic contour, Ascites, Splenomegaly | Bowel perforation, Gynecomastia, Azygos vein enlargement, Pleural effusion | Morphologic changes in the liver, Collaterals and shunts, Hyperattenuating nodule of hepatocellular carcinoma, Portal vein thrombosis | Vacular patency, Tumor invasion, Portal vein thrombosis, Steatosis | Hepatic function and portal hypertension in nuclear imaging, Hepatic perfusion and the development of shunts and tumors in angiography | Irreversible and a transplant is usually needed | |
| Malignant hypertension | +/- | - | + | - | - | +/- | - | +/- | +/- | Microangiopathic hemolytic anemia | ↑BUN, ↑Cr | ↑Na, ↑K, ↑P | Proteinuria, Microscopic hematuria | Acidosis | Cardiac enzymes, Urinary catecholamines, TSH, ↑Renin | NA | Cardiomegaly, Pulmonary edema, Rib notching, Aortic coarctation, Mediastinal widening, Aortic dissection | NA | NA | Left atrial enlargement and left ventricular hypertrophy in echocardiography | - | |
| Myocarditis | +/- | - | - | - | +/- | - | - | +/- | - | Leukocytosis (eosinophilia),↑ESR and CRP | NA | NA | NA | NA | Cardiac enzymes, Viral antibodies | NA | NA | NA | Inflammatory edema, Degree of scarring | Endomyocardial biopsy, Echocardiography, Scintigraphy | NA | |
| Peritonitis | +/- | - | +/- | - | +/- | +/- | +/- | - | - | Leukocytosis | NA | NA | NA | NA | Ascitic fluid neutrophil count > 500 cells/µL | NA | NA | NA | NA | - | - | |
| Polycythemia | +/- | - | - | - | - | - | - | +/- | - | ↑RBC, ↑HCT, ↑HGB, Thrombocytosis, Leukocytosis, ↑PT and aPTT | ↓Erythropoietin | NA | NA | NA | Hyperuricemia | Splenomegaly | NA | NA | NA | - | Phlebotomy is the usual treatment | |
| Respiratory distress syndrome | + | - | +/- | - | - | - | - | + | - | NA | NA | NA | NA | Metabolic and respiratory acidosis | Pulse oximetry | NA | Bilateral, diffuse, reticular granular or ground-glass appearance +/- Cardiomegaly | NA | NA | Patent ductus arteriosus in echocardiography | - | |
| Shock | +/- | +/- | +/- | +/- | +/- | +/- | - | +/- | - | ↑HCT, ↑PT and aPTT, Eosinophilia, Leukocytosis | ↓GFR, ↑BUN, ↑Cr | NA | NA | ↑Lactate | LFT, ↑BNP, ↑Troponin, D-dimer, Fibrinogen | Pulmonary embolism, Pericardial effusion, Cardiac tamponade, Pneumothorax, Thoracic or abdominal aortic aneurysm in RUSH (Rapid Ultrasound for Shock and Hypotension) | Pneumonia, Pneumothorax, Pulmonary edema, Widened mediastinum, Free air under the diaphragm | Traumatic brain injury, Stroke, Spinal injury, Pneumonia, Pneumothorax, Ruptured aneurysm, Aortic dissection, Pulmonary embolism | NA | - | - | |