A 53 yr old came to opd with cheif complaints of bilateral edema since 10 days, shortness of breath since 4 days , decreased urine output,facial puffiness and loss of appetite since 2 days HISTORY OF PRESENT ILLNESS: C/o B/L pedal odema since 10 days SOB since 4 days Decreased urine output Facial puffiness since 2 days Loss of appetite since 2 days HISTORY OF PAST ILLNESS known case of HTN since 1 1/2 yearand DM since 3 years. Alcoholic but stopped 3 years back GENERAL EXAMINATION: pallor No cyanosis No clubbing No icterus Bilateral pitting edema Vitals: Temp 97.5 F Pulse rate: 98/min RR: 27/min Bp: 160/90mm Hg Spo2 98% SYSTEMIC EXAMINATION CVS: NO thrills No cardiac murmurs RESP: Dyspnoea is present grade2-4 Wheezing present Position of trachea - central ABDOMEN: distended No tenderness No palpable mass Free fluid is present Liver and spleen not b