70 year old male with shortness of breath

A 70 year old male was brought to the casualty with c/o of
Fever since 6 days
Breathlessness since 5 days
Productive cough since 5 days
History of presenting illness: patient was apparently asymptomatic 6 days back then he developed fever of high grade, intermittent, associated with chills and rigors, relieved with medication.
Breathlessness since 5 days which is insidious in onset and gradually progressive to grade 4 since today morning.
Productive cough with white mucoid sputum of moderate quantity, non foul smelling, not blood tinged
No history of paroxysmal nocturnal dyspnoea,  history of orthopnea present, no history ot decreased urine output, no history of pedal edema, no history of abdominal distension
History of chest tightness, back pain
No history of vomitings, loose stools, facial puffiness, burning micturition

Past history: 
Patient is not a known case of htn, dm, asthma, cva, cad
Known case of pulmonary tb 5 years back
Used ATT 1.5 years back for 6 months
History of pleural tapping done twice ? H/o icd insertion 1.5 years ago.

Personal history: 
Patient is married, shepherd by occupation, lost his appetite, mixed diet, bowel movements are regular, with normal micturition, occasionally alcoholic and past smoker ( stopped 5 years back)

Family history:  No significant family history
No history of contact in family.

General examination:
Patient is thin built and poorly nourished
Well oriented to time place and person
Pallor present
No signs of icterus, cyanosis, clubbing, lymphadenopathy, oedema.
Temp: 99.4 degree Fahrenheit
Pr: 120 bpm
Bp: 110/ 70 mmhg
RR: 38 cpm
Saturation: 82 percentage at room air
Grbs: 87 mg/dl

Systemic examination:
Cvs:
S1 and S2 heard
No thrills
No murmurs
Respiratory system:
Trachea deviated to right
Usage of accesory muscles evident
Patient is dyspneic 
Wheeze present in rt IAA 
Breath sounds: tubular
Rt diffuse crepts and lt basal crepts present

INVESTIGATIONS:
Chest xray
Abg analysis:
Metabolic acidosis with respiratory alkalosis
Anion gap: 15

Provisional diagnosis: acute exacerbation of COPD
? CAP, ? Reactivation of old ptb
Prerenal AKI
HAGMA with ureamia

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