60 year old male presented in an unresponsive state

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.
I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. 


Patient present in an unresponsive state to the casualty since 2 hours
History of presenting illness
60 year old male presented to the casualty in unresponsive state 
Patient was apparently asymptomatic 1 day ago
H/i consumption of toddy last night followed by consumption of 2 quarters of alcohol and the patient did not have any food last night
Today morning the patient attenders found the patient was unresponsive since 4 hours when they forced him to take food
No h/o fever, involuntary movements of upper limbs n lower limbs, drooling of mouth, trauma, vomiting
Not a k/c/o Htn, DM,cad, thyroid, seizure disorder 
On examination
Patient is drowsy and unconscious
Temperature 96.2F
Pulse rate 124bpm
Respiratory rate 26per min
BP 150/100 mmhg 
Spo2 97 at room air 
GRBS 26mg/dl
Systemic examination
CVS s1s2 heard 
No murmurs
Rs bilateral air entry present
Per abdomen software non tender 
CNS 
Power normal in bilateral upper and lower limbs 
Reflexs B T S K A plantar
Left 2+. 1+. -. 2+. 1+. Flexion 
Right 2+. 1+. -. 2+. 1+. Flexion 
Sensory system couldn't be assessed
Cranial nerves couldn't be assessed
Gcs E1V1M4
No meningeal signs 

Provisional diagnosis
Unresponsive (hypomentation) secondary to hypoglycemia(corrected using25D) secondary to alcoholic ketoacidosis ? secondary to starvation ketoacidosis

Treatment
25D 100ml IV stat
Inj thiamine 2amp in 100ml NS IV stat 
Inj 25D 100ml if GRBS less than 60 mg/dl
Monitoring vitals
IVF NS and DNS 100ml/hr
Inj thiamine 1amp IV TID in 100ml NS
USG abdomen and pelvis done
Impression
No sonological abnormalities

Investigations
Ecg 
chest xray pa view
2d echo
Abg 
pH 7.248
Pco2 26.2
Po2 96.1
Hco3 13.6
Rbs 100
Serum urea 19
Cue pus cells 3-4
Albumin +
Bgt A positive
Hb 14.3
Tc 16000
Neutrophils 91
Lymphocytes 04
Pcv 46.2
Mchc 31
Rdw 16.5
Platelet 2.45
Lft 
Tb 0.64
Db 0.20.
Sgot 135
Sgpt 51
Alp 161
Total protein 6.6
Albumin 3.4
A/G 1.06
Serum creatinine 0.9
Urine for ketone bodies positive

Psychiatry referral

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