Differential Diagnosis
The patient presents with abdominal pain, lower left sided, rhythmic movement of the left hip, and neuropathy down the left leg to the bottom of the foot, along with specific laboratory findings. Here's a categorized differential diagnosis based on the provided symptoms and pathology results:
Single Most Likely Diagnosis
- Diabetic Neuropathy with Possible Left Hip or Lower Back Pathology: The presence of neuropathy down the left leg, abdominal pain, and rhythmic movement of the left hip could be indicative of a complex condition involving diabetes (suggested by the neuropathy and possibly the high MCH, MCV, and borderline high to high WBC, which could indicate infection or inflammation) and a musculoskeletal or neurological issue affecting the left hip or lower back. The laboratory findings of high base excess, bicarbonate, and alterations in blood cell parameters could support a chronic condition like diabetes with complications.
Other Likely Diagnoses
- Chronic Kidney Disease (CKD): Elevated creatinine levels suggest impaired kidney function. CKD can lead to neuropathy, and the electrolyte imbalances (like borderline low to low potassium) can cause muscle weakness and rhythmic movements.
- Inflammatory Bowel Disease (IBD): Abdominal pain, particularly if it's chronic, could be due to IBD. The high WBC and neutrophil/lymphocyte ratio support an inflammatory process. Neuropathy could be a complication of the disease itself or malabsorption.
- Peripheral Artery Disease (PAD): This condition could explain the neuropathy and rhythmic movement of the left hip due to reduced blood flow to the lower extremities. However, the specific laboratory findings would need to be correlated with imaging studies.
Do Not Miss Diagnoses
- Abdominal Aortic Aneurysm (AAA): Although less likely given the specific location of the pain (lower left sided), an expanding AAA could cause abdominal pain and, if it affects blood flow, could potentially lead to neuropathic symptoms in the legs. This is a medical emergency if ruptured.
- Spinal Cord Compression: This could explain the neuropathy and rhythmic movements. Causes could include tumors, abscesses, or fractures. Prompt diagnosis is crucial to prevent permanent neurological damage.
- Sepsis: The elevated WBC, neutrophil/lymphocyte ratio, and some of the other laboratory abnormalities could indicate a systemic infection. Sepsis is a life-threatening condition that requires immediate attention.
Rare Diagnoses
- Amyloidosis: This condition can cause neuropathy and could potentially explain some of the gastrointestinal symptoms if there's involvement of the autonomic nervous system. The laboratory findings would need to be correlated with specific tests for amyloidosis.
- Porphyria: A group of disorders that can cause abdominal pain, neuropathy, and psychological disturbances. Some forms of porphyria can lead to acute intermittent porphyria, which might explain some of the patient's symptoms, although this would be quite rare.
- Vasculitis: Conditions like polyarteritis nodosa could explain the combination of abdominal pain, neuropathy, and laboratory findings indicative of inflammation. However, vasculitis is relatively rare and would require specific diagnostic tests for confirmation.