Exam

A 58yr old male presented to casualty complaining of Shortness of breath grade 4 since 4-5 days worsening since 2 hours  Decreased urine output since 4-5 days  Pedal oedema on and off since 6 months  Now subsided ( outside medications )  He was apparently alright 8 years back developed pedal oedema and shortness of breath and was taken local hospital and was diagnosed to be diabetic and hypertensive and chronic kidney disease with baseline creatinine of 2.5mg/dl  He had recurrent episodes of sob and was admitted 1/2 times and was managed symptomatically  Since 10-12 days he developed fevers of high grade intermittent type not associated with chills, a/w cough with expectoration, scanty ( occasionally)  Decreased urine output since 4-5 days, no history of lower urinary tract symptoms ( urgency, hesitation, frequency, post voi dal residue )  And was also diagnosed with peri anal abscess/pilonidal sinus and was referred to our hospital for further management  On admission  Patient conscio