65yr old with pedal edema

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A 65 yr old man ,driver by occupation diagnosed with diabetes 15 yrs back came with
chief complaints of

Pedal oedema since 15 days
Sob since 5 days
Decreased urine output since 3 days
Fever since 5 days

History of presenting illness :
Patient was apparently asymptomatic 15 days back ,then developed pedal oedema upto ankle ,which is pitting type,

shortness of breath since 5 days  which is grade 4,
Fever since 5 days ,which is continous,associated with vomiting n cough

Vomiting of one episode which bilious n non projectile 5 days back

Cough since 5 days with sputum,which is red in colour reduced after medication

Past history 
He had a history of giddiness for which he went to hospital and
Diagnosed with Diabetes since 15 yrs

Had history of TB 15 yrs back ,which is treated with medication
Diagnosed with HTN 2 yrs back

Not known case of asthma,cardiovascular disorder n thyroid disorders

Personal History:
Alcoholic since 30 yrs

Family hisotry:
Not significant

General examination:
Patient was coherent,conscious,coperative
Mild -pallor ,No cyanosis,clubbing,lympadenopathy
Pedal odema since 15 days
VITALS
Temp 99.6F
Bp 140 /80 mm Hg
PR 85 bpm
RR 26 cpm
GRBS :237 mg


Systemic examination
 CVS : S1,S2 +
 RS : BAE +
Per abdomen : soft ,non tender
CNS: NAD
INVESTIGATIONS:

ECG:



Provisional diagnosis:
Diagnosed with Diabetic nephropathy .


TREATMENT Plan:


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