We present the case of a 28-year-old male with a history of alcohol dependency and smoking, who presented with chest pain, shortness of breath, and altered sensorium. He exhibited severe metabolic acidosis, low platelet count, and acute kidney injury. Alcoholic ketoacidosis (AKA) was suspected due to ketonuria, metabolic acidosis, and ketonemia, compounded by electrolyte abnormalities and radiographic findings of pneumonia.Prompt intervention included electrolyte correction, thiamine supplementation, broad-spectrum antibiotics, and diuretics. Thiamine played a pivotal role in the patient's recovery, with significant improvement in consciousness observed within a day. After six days, the patient was discharged in stable condition, showing normal renal and hepatic function during follow-up.This case emphasizes the need for early recognition and comprehensive management in AKA, highlighting thiamine's crucial role in treatment success.

Ebstein anomaly, a congenital heart condition, can manifest across a broad age spectrum, including adulthood. We present a unique case of a 67-year-old woman with no significant medical history who sought medical attention for severe headaches, vomiting, and respiratory distress, accompanied by elevated blood pressure and rapid pulse. Initial investigations, including troponin T levels, yielded unremarkable results. However, an electrocardiogram unveiled a right bundle branch block (RBBB) pattern, prompting further assessment. A subsequent chest X-ray disclosed an enlarged heart, indicating cardiomegaly, prompting echocardiography. The echocardiogram confirmed the diagnosis of Ebstein anomaly, revealing a 26 mm apical displacement of the tricuspid valve (TV). The patient was managed conservatively with supplemental oxygen and exhibited gradual improvement. This case underscores the infrequent occurrence of Ebstein anomaly in adulthood and underscores the necessity for thorough evaluation in cases of unexplained cardiopulmonary symptoms.