A 32 year ald male

 complaints:
Patient complaining of decreased appetite since 10 days , fever since 10 days
Vomiting since 7 days associated with pain in abdomen,
History excessive alcohol intake since 1 month , aggrevated since last 7 days
Loss of weight since 10 days 
No H/O fever and lose stools

History of presenting illness : 
Patient is asymptomatic 10 days back then he had loss of appetite and took no food since then and had excess of alcohol . He developed low grade fever 10 days back , sudden in onset , low grade , intermittent , relieved on medication, associated with rigors , no sweating and no evening rise of temperature.
Vomiting since 7 days back , multiple episodes in a day like every 1 hour , bilious, Foul smelling, non projectile , not associated with abdominal pain , no headache, no diminision or blurring of vision .

Past history: 
No history of Diabetes mellitus, Hypertension, TB , Asthma and No history of any cardiovascular disease

History of 2 episodes of admission in hospital in view of jaundice which relieved on medication.


Personal history: 

Married 
Labourer by occupation
Appetite - Lost 
Non vegetarian
Bowel movements are irregular 
Passage of urine - Normal
No known allergies 
Addiction - Drinks alcohol daily ( whisky) , 90-180 ml before dinner.

No significant Family history .

General examination: 
Patient is well oriented to time , place and person, but irritable and unresponsive .
Weight - 39 kg 

Pallor - present 
icterus - present 
Cyanosis.                         
Clubbing.        } ABSENT
Lymphadenopathy 

Pulse - 120 bpm
BP - 120 / 70 mmHg
SpO2 - 98% 
GRBS - 93 mg %


Systemic examination : 
CVS examination:
S1 , S2 heard 
No murmurs detected 

Respiratory system examination: 
No wheeze , No Dyspnea 
Trachea - central 
Breath sounds - Vesicular

Abdominal examination : 
Inspection:
Shape - scaphoid, symmetrical
No change in colour of skin .
No striae , brushing or scar 
No dilated veins 
No abdominal swelling
Umbilicus central 

Palpation: 
No tenderness
Guarding and rigidity are absent, No rebound tenderness 
Hepatosplenomegaly detected with liver span of 20 cm
Spleen is palpable
Abdomen is rigid 

Percussion - liver span is 20 cm approx
Auscultation : Normal bowel sounds

Provisional diagnosis:
Alcoholic ketoacidosis
Starvation ketoacidosis 

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