52 year old male with hiccups

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .
I’ve 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.

Case : 
Pt c/o hiccups since 5 days 
up rolling of eyeballs and frothing since morning 

Chief complaints: 
54 year male came to casualty on 27-10-22 with complaints of hiccups since 5 days and up rolling of eyeballs and frothing since morning 

HOPI: 
Pt was apparently asymptomatic 5 days back then he had hiccups for 5 days 
He had up rolling of eyeballs and frothing since morning not associated with any involuntary movements or involuntary micturition 

Past history: 
He had similar episodes of hiccups 6 months back 
2 months back he was admitted in hospital and was found out to have hypokalemia 
K/c/o DM since 7 years 
( he had trauma 5 years back to foot which was not healing properly so he went to the hospital and was diagnosed as diabetic) 
Initially he took medication but his sugars were not under control 
Then he was switched to insulin under doctor’s advice 
20U in the morning and 15 units in the night since 3 months 
N/k/c/o HTN, asthma , epilepsy, cad, cvd 
H/o trauma to head ( Rta -bike skid) 1 month back he had a Laceration 

Personal history : 
Diet : mixed 
Appetite: normal 
Bowel and bladder habits: regular 
Addictions: none 
Sleep : adequate 

Family history: 
Insignificant 

General examination: 
Pt is conscious coherent and cooperative 
Delayed response 
Moderately built and nourished 
Pallor , icterus, cyanosis, clubbing , lymphadenopathy, edema are absent 
Vitals: 
Temp; 98
BP: 140/80
PR: 82 bpm
RR:20/min 
Systemic examination: 

CVS: s1 s2 heard 
        No murmurs 
Respiratory system; normal vesicular breath sounds are heard 
Abdomen: soft non tender no organomegly

CNS;
Higher functions:
Right handed 
Conscious 
Delayed response 
Oriented to time place and person 
Memory: recent- present 
              Immediate: present 
              Remote: present 
Speech: slurred 
Provisional diagnosis: 
Altered sensorium 
? Hypoactive delirium secondary to dyselectrolytemia 
CKD ( diabetic nephropathy) 

Treatment : 
On 29-10-22
1) Iv fluids NS @30ml/hr 
2) inj pan 40mg iv OD 
3) syp potchlor 15ml in glass of water po tid 

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