This patient presented with vomiting, fever, rapid breathing, and a history of heavy alcohol consumption, all of which disrupted his fluid balance. Specifically, vomiting, sweating from fever, and hyperventilation caused fluid loss, while alcohol inhibited anti-diuretic hormone leading to increased urine output and further fluid loss. Laboratory tests found an elevated osmolal gap, indicating the presence of unmeasured solutes like ethanol that were disrupting fluid balance. Close monitoring and intravenous fluid replacement were needed to restore normal fluid balance.