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 
1 year back.Then his wife noticed that he was becoming thin.So they went to a general physician where he was diagnosed with diabetes mellitus for  he was started on oral hypoglycemic drugs. After 10 months he had fever for 3 weeks with cough associated with sputum, for which he consulted a doctor and was diagnosed with tuberculosis.He was started on anti tubercular drugs for a period of 6 months.He is an occasional binge drinker(once in 2-3 months).He was asked to quit drinking till the completion of ATT regimen.He stopped drinking alcohol for 2 months.However 7 days back he had a binge drink without taking any food following which he developed abdominal pain which was insidious in onset,diffuse all over the abdomen and there was no alleviation of pain with change in position.It was not associated with nausea and vomiting.The followed day he developed a state of confusion and just a day back he became breathless which was insidious in onset,persistent in nature and  not relieved by any change in position.He  has history of weight loss.There was no history of  fever,swelling of legs, Orthopnoea,PND.

PAST HISTORY:
He is on ATT since 2 months and oral
 hypoglycemic drugs since 1 year
No history of any hospitalization in the past
No history of asthma, hypertension ,CVA,CAD and thyroid disease.

PERSONAL HISTORY:
He is a shepherd by occupation.
Married and has two children( a boy and a girl)
He is an occasional binge drinker and a smoker
He has normal appetite , takes mixed diet,
with regular bowel and increased frequency of micturition since 1yr and
has adequate sleep 
No known history of food and drug allergies

FAMILY HISTORY:
No history of Diabetes ,Hypertension,Tuberculosis,CVA,CAD,
Asthma

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:18 cpm
Blood pressure: 124/76 mm of Hg
Afebrile

No Pallor ,Icterus, Clubbing,Lymphadenopathy,Pedal edema,
Koilonychia

Head to toe examination:Normal

CNS EXAMINATION:

GCS SCORE:
Eye opens spontaneously(4)
Verbal response :Incomprehensible Speech(2)
Motor response: Withdraws pain(4)
Total Score:10

DIFFERENTIAL DIAGNOSIS:
Acute pancreatitis
Diabetic ketoacidosis
Dengue fever with serositis and pleural effusion 
Myocardial infarction
Basal pneumonia


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