Alcoholic acidosis? wet beri beri? Acute pancreatitis? AKI secondary to dehydration

35 YR OLD MALE PATIENT CAME TO CAUSALITY WITH 
C/o shortness of breath since morning
C/o pain abdomen since Monday (3-4days)
C/o chest pain ( left sided since 4 days )
C/o decreased urine output since 2 days
C/o hematuria since morning
C/o vomitings since morning
Patient was apparently asymptomatic 4 days back then he developed shortness of breath ( grade III- grade IV ) h/o binge drinking of alcohol since 10days without eating food.
C/o pain abdomen ( diffuse type of pain ) associated with vomitings ( food particles as content ), non projectile
C/o chest pain left sided not associated with sweating ,palpitations, orthopnea , PND
C/o hematuria since morning
C/o decreased urine output since 2 days
Not a Known case of DM,HTN
Alcoholic since 20 years ( 100ml/day)
H/o visited RMP 3 days back I/v/o generalized weakness and vomitings

Physical examination
No signs of pallor,cyanosis,clubbing, lymphadenopathy,edema
Icterus ++

Vitals -
Temp: 98.5 F
PR: 112 bpm
RR : 22 cycles
BP : not recordable
SpO2 : 64% at RA
99% with 10liters of O2
GRBS : 135 mg%

Systemic examination.
CVS : S1S2 heard no murmurs
RS : Dyspnea + ( grade III - grade IV )
NVBS +
P/A : Diffuse type of pain all over the abdomen


Provisional diagnosis : ? Alcoholic ketoacidosis ? Wet beriberi ? Acute pancreatitis ?AKI secondary to dehydration
Treatment given:
Iv fluids -Ns @75ml/hr.
    Inj .Tramadol Iv/ BD
    Inj .Midaz 2cc / IV / sos          if restless .
 Inj .Meropenam 1gm / Iv / BD .
      Inj .pan 40 mg / Iv / OD
   Inj .Zofer 4 mg/ Iv/sos 
   Inj .Thiamine 100 mg /IV / TID.

4 sessions of Hemodialysis done .
Stool for occult blood negative .

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