The commonest cause of medical admission in the over 60s. Pulmonary oedema is uncommon and usually precipitated by some acute event, such as acute coronary syndrome or arrhythmia. Treatment should be directed to the underlying cause. Much more common is fluid retention. The treatment is aggressive diuresis, unfortunately commonly poorly handled. Bed rest, continuous infusion of adequate dosage of furosemide and the addition of thiazide diuretic where needed are the cornerstones of management. A decline in renal function is NOT a reason to stop diuretic therapy in those with fluid overload.