Differential Diagnosis for Abdominal Pain with High Eosinophils, Low CO2, Elevated BUN, and Elevated Lipase

Single Most Likely Diagnosis

• Acute Pancreatitis: The elevated lipase level of 345 is a strong indicator of pancreatitis. High eosinophils could be seen in various conditions but when combined with abdominal pain and elevated lipase, it points towards an inflammatory process like pancreatitis. Low CO2 (indicating metabolic acidosis) and elevated BUN (indicating possible dehydration or renal impairment) are also consistent with severe pancreatitis.

Other Likely Diagnoses

• Eosinophilic Gastroenteritis: This condition involves the stomach and intestines and is characterized by high eosinophil counts. It can cause abdominal pain and could potentially lead to elevated pancreatic enzymes due to the inflammatory process affecting the pancreas indirectly.
• Acute Kidney Injury (AKI): Elevated BUN could indicate AKI, which might be secondary to dehydration or another cause. However, the combination with abdominal pain and elevated lipase suggests a more complex scenario, possibly involving multiple organ systems.

Do Not Miss Diagnoses

• Mesenteric Ischemia: Although less likely, this is a critical diagnosis not to miss due to its high mortality rate. Abdominal pain out of proportion to physical examination findings, elevated BUN (possibly indicating renal impairment), and metabolic acidosis (low CO2) could be seen in mesenteric ischemia. Eosinophilia is not a typical finding but could be present in the context of a severe inflammatory response.
• Sepsis: Sepsis can cause abdominal pain, elevated BUN, metabolic acidosis, and could potentially lead to elevated lipase if the pancreas is involved. High eosinophils are not typical in sepsis but could be seen in specific infections or as part of a stress response.

Rare Diagnoses

• Hypereosinophilic Syndrome (HES): A rare condition characterized by persistent eosinophilia that can affect multiple organ systems, including the gastrointestinal system. It could potentially cause abdominal pain and elevated pancreatic enzymes but would be an unusual presentation.
• Eosinophilic Pancreatitis: A rare form of pancreatitis characterized by eosinophilic infiltration of the pancreas. It would explain the abdominal pain, high eosinophils, and elevated lipase but is exceedingly rare and usually part of a broader eosinophilic disorder.