A 42 year old male with altered sensorium and fever

A pt was brought to a hospital with chief complaints of 
altered sensorium since yesterday and fever since yesterday
HOPI;
Patient was apparently asymptomatic 3 years back,then he started sleep taking at night time with shouting in between ,also abuses his wife gets angry for small reasons,used to abuse his coworkers also near work place.
This continued till last Sunday,then patient was taken to Hyderabad(rehabilitation centre) on last Sunday and was admitted there after which he was normal for 4 days and then since Friday started abusing everyone.
From today morning he was in altered sensorium and was drowsy and was brought to a hospital.
Complaints of fever since yesterday which is insidious gradually progressive not associated with chills and rigor.No aggrevating factors and relieved with medication.
PAST H/0:
Not a k/c/o DM,HTN,THYROID,ASTHMA,EPILEPSY.

PERSONAL HISTORY:
Marital status-Married
Occupation- Farmer
Diet: mixed
Appetite: normal
Bowel and bladder : Normal
Addictions:Alcoholic since 20 years(increased intake since 10 years

FAMILY HISTORY:
No similar complaints in the family.

GENERAL EXAMINATION:
Patient is examined in a well lit room with adequate exposure, after taking the consent of the patient.
he is drowsy.
Built & nourishment-Moderate
No pallor 
No cyanosis
No icterus
No clubbing
No edema
No lymphadenopathy.
SYATEMIC EXAMINATION:
CVS : 
S1 S2 present
No murmurs

RESPIRATORY SYSTEM;
B/l symmetrical chest
Trachea - Central
B/l air entry present
NVBS heard

ABDOMEN:
Shape of abdomen: scaphoid.
Soft, non tender, no organomegaly present.
No rigidity or guarding.

CNS :
Patient is conscious
Speech-normal 
Signs of meningial irritation
Neck stiffness- negative
Kernings sign-negative
Cranial nerves-intact
Motor system:
Power:
            R.                 L
UL.     5/5.             5/5
LL.      5/5.             5/5
 
Tone:
            R.                  L
UL.      Normal.      Normal
LL.       Normal    normal
Sensory system: normal
Reflexes:
           Knee. Ankle. Biceps. Triceps supinator
Right    2+.     1+.        2+          1+.          1+
Left.     2+.     1+.         2+          1+            1+
Plantar flexion seen.
No cerebellar signs


TREATMENT:
1.IV FLUIDS NS @50ML/HR
2.INJ.THIAMINE 100MG IN 100 ML NS IV/TID
3.INJ.OPTINEURON 1AMP IN 100ML NS I /OD
4.INJ.NEOMOL 1GM IV/SOS
5.TAB.SDOLO 650 MG PO/SOS

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