MRCP2-0800

MRCP2-0800

A 55-year-old man is brought into the emergency department by the police. He appears drowsy and confused, with an unkempt appearance. Unfortunately, he is unable to provide a coherent history due to his confusion. Upon examination, his pulse rate is 60 beats per minute, blood pressure is 90/60 mmHg, respiratory rate is 23 per minute, and his temperature is 35.2°C. There are no remarkable findings upon examination of his heart, lungs, and abdomen. There is no evidence of a focal neurological deficit, but his eyes open to pain, pupils are dilated with absent light responses, and his speech is slurred and incoherent. His serum alcohol level is 0.78 g/L. An arterial blood gas test reveals a pH of 7.30, pO2 of 10.1 kPa, pCO2 of 2.9 kPa, sodium of 142 mmol/L, chloride of 100 mmol/L, potassium of 4.2 mmol/L, bicarbonate of 12.9 mmol/L, urea of 9.2 mmol/L, and creatinine of 103 μmol/L. His glucose level is 8.4 mmol/L. A urine dipstick test is positive for 1+ ketones and 1+ leukocytes, but negative for nitrites. What is the most likely diagnosis?