58 yr old male with sob and decreased urine output

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I have been given this case to solve in an attempt to understand the topic of "Patient clinical data analysis" to develop my competency i reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

Chief complaints: 

Decreased urine output since 5 days

Pedal edema since 5 days

Episode of fainting 3 days back

HOPI:

Patient was apparently asymptotic 5 days back then he developed decreased urine output and pedal edema then went to a local doctor but the symptoms did not subside. Then he went to hyderabad and received treatment, and felt better. 3 days ago patient had an episode of hypoglycemia and was brought to our hospital

PAST HISTORY: 

K/c/o diabetes since 15 years

K/c/o hypertension since 5 years

History of hypoglycemia 4 years back

History of blebs on toes when he missed the oral hypoglycemics for 2 to 3 days

He had an episode of paralysis of left side 

5 years back which resolved within one hour on treatment 

PERSONAL HISTORY:

Diet:mixed

Appetite:normal

Bowel movements are regular, bladder : decreased urine output 

Addictions: alcohol consumption from past 30years (375ml alcohol 3 to 4 times a week)

No know allergies 

FAMILY HISTORY:

father was a known case of diabetes

Mother was known case of hypertension

GENERAL EXAMINATION:

Patient is conscious coherent and cooperative

built: well built and well nourished

Pallor: absent

Icterus: absent

Clubbing: absent

Cyanosis: absent

Lymphadenopathy: absent

Edema: bilateral pitting edema is seen

VITALS: 

7/10/22

temp: 94.6°f

PR:100 bpm

BP:190/100 mm Hg

RR:16 cpm

RBS: 55 mg/dl

Spo2: 98%

8/10/22

temp: 98.0°f

PR:103 bpm

BP:140/80 mm Hg

RR:18 cpm

RBS: 137 mg/dl

Spo2: 99%

SYSTEMIC EXAMINATION:

CVS: S1 S2 heard, no murmurs heard

RESPIRATORY: BAE +, NVBS heard

P/A: abdomen distended, there are multiple hyperpigmented spots on the right side of the abdomen. Abdomen is soft and nontender on palpation 

CNS no focal neurological deficits 

INVESTIGATIONS:

USG