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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 - -
  1. Cash RA, Music SI, Libonati JP, Snyder MJ, Wenzel RP, Hornick RB (January 1974). "Response of man to infection with Vibrio cholerae. I. Clinical, serologic, and bacteriologic responses to a known inoculum". J. Infect. Dis. 129 (1): 45–52. PMID 4809112.