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 | Not applicable | ↓HCO3 | Abnormal LFT | Not applicable | Not applicable | Not applicable | Not applicable | - | Thiamine must be given to prevent Wernicke's encephalopathy |
| Aspergillosis | +/- | - | - | - | - | - | - | +/- | - | Not applicable | Not applicable | Not applicable | Not applicable | Not applicable | Allergy test, ↑IgE (>1000 IU/dl), direct visualization of fungal hyphae | Not applicable | 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 | Not applicable | - | Polymerase chain reaction (PCR) confirms the diagnosis | |
| Cholera[1] | +/- | + | - | - | - | +/- | + | - | - | Leukocytosis, ↑HCT | ↑BUN, ↑Cr | ↓Na, ↑Ca, ↑Mg | Not applicable | ↑Lactate, ↓HCO3 | Stool PCR, stool culture, serotyping | Not applicable | Not applicable | Not applicable | Not applicable | - | - | |
| Congestive heart failure (CHF) | + | - | - | - | - | - | + | +/- | + | Anemia, leukocytosis | ↑BUN, ↑Cr | ↓Na, ↑K | Not applicable | ↑Lactate, ↓HCO3 | ↑BNP, ↑Troponin | Cardiomegaly, pulmonary hypertension, pleural effusion | Pulmonary edema | Not applicable | Valvular heart disease | Decreased ejection fraction in echocardiography, decreased heart function and damage in nuclear imaging | - | |
| Dehydration | + | + | +/-
Depends on the severity |
+/- | - | +/- | +/- | - | - | Not applicable | ↑BUN, ↑Cr | ↓Na, ↑K, ↓Cl | ↑Ketones and glucose, ↑urine specific gravity | ↑Lactate, ↓HCO3 | Hypoglycemia | Not applicable | Not applicable | Not applicable | Not applicable | - | - | |
| Diarrhea and/or vomiting | +/- | +/- | - | - | - | + | + | - | - | Leukocytosis with predominant neutrophilia, ↑ ESR | Not applicable | Not applicable | Ketones, Organic acids, Porphobilinogen, Aminolevulinic acid | Not applicable | Stool anion gap, Stool pH < 5.5, Stool culture, Serotyping, Enzyme immunoassay (rotavirus or adenovirus), LFT, Amylase, Lipase | Normal | Not applicable | Not applicable | Not applicable | - | - | |
| Drugs/toxins | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | Not applicable | ↑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 | Not applicable | Not applicable | - | - | |
| Esophageal varices bleeding | +/- | - | - | - | +/- | - | - | - | - | Normocytic normochromic anemia | ↑BUN, ↑Cr | Not applicable | Not applicable | Not applicable | Not applicable | 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 | Not applicable | Not applicable | Not applicable | Throat culture, Rapid streptococcal antigen test, Hyperoxia test, Pulse oximetry | Not applicable | Cardiomegaly, Dextrocardia | Not applicable | Not applicable | Ventricular dysfunction, Left and right ventricular hypertrophy, Valvular disease in echocardiography | - | |
| Hemorrhage | - | - | - | - | - | - | - | - | - | Normocytic normochromic anemia, ↑PT, ↑PTT | ↑BUN, ↑Cr | ↑Na, ↑Cl, ↓Ca | Not applicable | Metabolic acidosis | Not applicable | Peritoneal cavity fluid in FAST | Bilateral opacities in the lung field, Hemothorax, Hemoperitoneum, Ruptured abdominal aortic aneurysm | Intrathoracic, intra-abdominal, and retroperitoneal bleeding | Not applicable | Source of bleeding in the upper GI in EGD, Angiography | - | |
| Hemolysis | +/- | - | - | - | - | - | - | - | - | Thrombocytopenia, Microcytic hypochromic anemia, ↑RDW, ↑Retic count | Not applicable | Not applicable | Not applicable | Not applicable | ↑LDH, ↓Haptoglobin, ↑Unconjugated bilirubin | Hepatomegaly,Splenomegaly | Not applicable | Not applicable | Not applicable | - | - | |
| 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 | Not applicable | Alpha feto-protein, Cryoglobulinemia | Exclude hydronephrosis and intrinsic renal disease | Not applicable | Not applicable | Not applicable | Right ventricular preload, ventricular filling pressures, and cardiac function in echocardiography | - | |
| Ischemic cardiomyopathy | +/- | - | - | - | - | - | - | +/- | +/- | Anemia | ↑Cr | ↓Na, ↓K, ↓Mg | Not applicable | Not applicable | Troponin, Creatine kinase, Creatine kinase - MB, BNP | Not applicable | 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 | +/- | - | +/- | +/- | +/- | - | - | - | +/- | Not applicable | Not applicable | Not applicable | Not applicable | Not applicable | 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 | Not applicable | Cardiomegaly, Pulmonary edema, Rib notching, Aortic coarctation, Mediastinal widening, Aortic dissection | Not applicable | Not applicable | Left atrial enlargement and left ventricular hypertrophy in echocardiography | - | |
| Myocarditis | +/- | - | - | - | +/- | - | - | +/- | - | Leukocytosis (eosinophilia),↑ESR and CRP | Not applicable | Not applicable | Not applicable | Not applicable | Cardiac enzymes, Viral antibodies | Not applicable | Not applicable | Not applicable | Inflammatory edema, Degree of scarring | Endomyocardial biopsy, Echocardiography, Scintigraphy | Not applicable | |
| Peritonitis | +/- | - | +/- | - | +/- | +/- | +/- | - | - | Leukocytosis | Not applicable | Not applicable | Not applicable | Not applicable | Ascitic fluid neutrophil count > 500 cells/µL | Not applicable | Not applicable | Not applicable | Not applicable | - | - | |
| Polycythemia | +/- | - | - | - | - | - | - | +/- | - | ↑RBC, ↑HCT, ↑HGB, Thrombocytosis, Leukocytosis, ↑PT and aPTT | ↓Erythropoietin | Not applicable | Not applicable | Not applicable | Hyperuricemia | Splenomegaly | Not applicable | Not applicable | Not applicable | - | Phlebotomy is the usual treatment | |
| Respiratory distress syndrome | + | - | +/- | - | - | - | - | + | - | Not applicable | Not applicable | Not applicable | Not applicable | Metabolic and respiratory acidosis | Pulse oximetry | Not applicable | Bilateral, diffuse, reticular granular or ground-glass appearance +/- Cardiomegaly | Not applicable | Not applicable | Patent ductus arteriosus in echocardiography | - | |
| Shock | +/- | +/- | +/- | +/- | +/- | +/- | - | +/- | - | ↑HCT, ↑PT and aPTT, Eosinophilia, Leukocytosis | ↓GFR, ↑BUN, ↑Cr | Not applicable | Not applicable | ↑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 | Not applicable | - | - | |