A 19 year old male patient from miryalguda studying Degree first year has come to the Opd with chief complaints of Vomiting since 3 days Shortness of breath on 24th march Chest pain on 24 th march Hopi Patient was apparently asymptomatic one and half yr ago,then in the 1st 6 months -he noticed gradual loss of weight ,patient had history of polyuria,nocturia,polydypsia https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1 He was diagnosed as Diabetic and during the hospital stay on day 5 he went to coma for 7 days, then recoverd which was due to acute fulminant hepatic failure . And discharged after 20 days 4 months back he developed vomitings , which was projectile type , food and water as it’s content Now , Vomiting are 2-3 episodes /day , projectile, food and water as contents non bilious and not blood tinged SOB: insidious in onset, patient feels like it’s due to increased sugar levels and decreased on taking insulin Chest pain: pain ov