50 yr old patient with abdominal pain and shortness of breath

 A 50 yr old patient who is a resident of nalgonda and labourer by occupation came with chief complaints of abdominal pain since 4 days,altered sensorium since 4days and shortness of breath since 1 day.
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 1yr back.Then his wife noticed that he was becoming thin.so they went to a hospital where he was diagnosed with diabetes.then he was started on medication for diabetes( oral). After 10 months he had fever for 3 weeks with cough associated with sputum.Then he consulted a doctor where he was diagnosed with tuberculosis.Then he was started on anti tubercular drugs which were supposed to be taken for 6 months.He is an occasional binge drinker(once in 2-3 months).He was asked to stop drinking till the completion of ATT regimen.so he stopped drinking alcohol for 2 months.Then 7 days back he had a binge drink without taking any food.Then he developed abdominal pain which was insidious in onset,diffuse over the abdomen.It is not associated with nausea and vomiting.After 1 day he developed confusional state.1day back he had short ness of breath which was insidious in onset,persistant in nature not relived by any change in position.He has weight loss.It is not associated with any fever,swelling of legs,orthopnoea,Pnd
PAST HISTORY:
He is on ATT since 2 months and on oral hypo glycemic drugs since 1 yr
No significant surgical history
No history of asthma,hypertension,cva,cad,thyroid.
PERSONAL HISTORY:
He is a shepherd by occupation.
He is an occasional binge drinker and smoker
Appetite:normal
Diet:mixed
Bowel:regular
Bladder: increased frequency since 1yr
Sleep:adequate
No known food and drug allergies
FAMILY HISTORY:
No history of diabetes,hypertension,tb,cad,cva.
GENERAL EXAMINATION:
He is conscious,but non cooperative and non coherent.
Patient is thin built and poorly nourished.
VITALS:
Pulse rate:80 BPM
Respiratory rate:18cpm
Blood pressure:124/76
Afebrile

Pallor:no
Icterus:no
Clubbing:no
Lymphadenopathy:no
Pedal edema:no
Koilonychia:no
Head to toe examination:normal
CNS EXAMINATION:
GCS SCORE:
eye opens spontaniously(4)
Verbal response:incomprehensible speech(2)
Motor response:withdraws pain(4)
Total score:10
DIFFERENTIAL DIAGNOSIS:
Acute pancreatitis
Diabetic keto acidosis
Dengue
Myocardial infarction
Basal pneumonia


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