Presenting Complaints

The patient presents with a chief complaint of frequent urination for the past 2-3 weeks.

History of Presenting Complaint

The patient reports having to urinate every 1-2 hours, even during the night. He has also noticed increased thirst and has been drinking more water than usual. The patient reports classic symptoms of polyuria, polydipsia, and unintentional weight loss, which are highly suggestive of untreated diabetes mellitus. He denies any burning or pain with urination. He has not experienced any fevers, chills, or other concerning symptoms.

Significant Positives & Negatives For Differentials

Type 1 Diabetes Mellitus

Positives:

• Polyuria, polydipsia, and unintentional weight loss - classic triad of symptoms
• Young patient age
• Family history of type 2 diabetes (increased risk of autoimmune diabetes)
• No other significant past medical history

Negatives:

• Lack of other typical symptoms like blurred vision, fatigue, or diabetic ketoacidosis

Diabetes Insipidus (Central or Nephrogenic)

Positives:

• Polyuria and polydipsia can be similar to diabetes mellitus
• Lack of other urinary symptoms like dysuria or hematuria

Negatives:

• Typically presents with more severe polyuria and polydipsia than described
• Unlikely in a young patient without neurological symptoms or other endocrine disorders

Urinary Tract Infection

Positives:

• Increased urination frequency can be a symptom

Negatives:

• Lack of dysuria, fever, or other typical UTI symptoms
• Unlikely to cause isolated polyuria without other urinary tract symptoms

Past Medical History

The patient reports no significant past medical history. He has not been diagnosed with any chronic conditions.

Drug/Medication History

The patient takes no regular medications. He denies any recent antibiotic or other prescription drug use.

Social History

The patient is a 21-year-old male who lives in Canada. He is a university student and works part-time at a local restaurant. He denies any tobacco, alcohol, or recreational drug use.

Family History

The patient's family history is notable for type 2 diabetes in his maternal grandmother. There is no family history of other endocrine disorders.

Systems Review

• Constitutional: The patient reports a 5-pound unintentional weight loss over the past month.
• Genitourinary: As noted in the chief complaint, the patient has experienced frequent urination, up to every 1-2 hours, as well as increased thirst and water intake. The patient denies any other concerning symptoms like blurred vision, fatigue, or signs of diabetic ketoacidosis, making diabetes insipidus less likely.
• All other systems are reviewed and are negative for any other concerns.

Ideas, Concerns & Expectations

The patient is concerned that his frequent urination may be a sign of a serious underlying condition. He is hoping the doctor can determine the cause and provide appropriate treatment.

Case Presentation

Based on the patient's history and symptoms, the most likely diagnosis is type 1 diabetes mellitus. The classic triad of polyuria, polydipsia, and unintentional weight loss, along with the patient's young age and lack of other significant medical history, strongly point to untreated diabetes as the underlying cause of the patient's frequent urination. Further laboratory testing to confirm elevated blood glucose and glycosylated hemoglobin levels would be the next appropriate steps.