Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: diabetic ketoacidosis major surgical or invasive procedure: right subclavian central line placement right arterial line placement mutliple peripheral iv placement history of present illness: 29 yof w/ h/o dm1 followed by as an outpatient brought to the ed by husband after having been found w/ altered mental status. she was found in the ed to be in dka. at presentation, it seemd per her husband's report that it was unlikely she was following her prescribed insulin regimen (he reported "leftover insulin" and that she had told him her new "insulin pen" was not functioning properly). post-admission questioning showed that she had basically quit her lantus regimen, and was furthermore not using he new humalog "insulin pen" properly. the patient has known gastroparesis and, per her husband's report, she has "flares" once every month or two at which time she has increased nausea +/- vomiting, abdominal discomfort, and decreased po; episodes normally resolve in days. he reports that yesterday pt. had onset of her "normal" symptoms of nausea, mild abdominal discomfort, no vomiting, small amount of diarrhea. no fevers/chills. no dysuria. she took off work this morning. when he returned from work, found her in bed somnolent although arousable. originally thought she was hypoglycemic so gave her juice that she was able to swallow. he then checked fs which was too high for glucometer read. she was then taken to the ed for further evaluation and management. past medical history: - dm1 --> per outpatient pcp note, patient has been poorly compliant with her long acting inuslin (lantus) and had not been taking it regularly. last hgba1c pta was 15.9 on . - diabetic gastroparesis - ibs - amenorrhea --> thought to be dm1 - pyloric stenosis - hypercholesterolemia (t. cholesterol 325, ldl 176, triglycerides 698, hdl 99 in ) social history: lives at home w/ husband, no tobacco, rare etoh. works w/ youth in the community. family history: per outpatient notes: mother with disease. father alive and well. sister with type 2 diabetes prader-willi syndrome. maternal history in her family of cad. maternal grandfather with a cardiac tumor. physical exam: pe: wt. 57.5 (after 7l in ed) t 91.5 axillary hr 110 bp 108/71 rr 22 100%2l gen: somnolent, arousable to voice, follow simple commands. states location and year as 98.6 (on later eval. states she is in the icu at ). skin: no rashes, cool upper and lower extremities, not diaphoretic heent: left pupil sl. > diam. than right (normal per pt's husband), both reactive to light. dry mm. neck: supple, no lad cv: sinus tachy, no mrg resp: ctab, no w/r/r abd: soft, typanitic over upper abdomen, nontender, no rebound/guarding ext: temp. as above, 2+ pt, dp pulses b/l neuro: ms as above, moving all four extremities and following commands, squeezes b/l hands, intact dorsi/plantar flexion. pertinent results: ed labs: 1800 - 16.7\13.1/430 |112|26 /817 abg: 6.79/18/218 free ca 1.35 /44.3\ 5.7| 2 |1.0\ lactate 1.9 - pt 10.4 ptt 24.0 inr 0.9 ca 10.0 phosphate 9.1 mg 2.9 - acetone - large amt - plasma osms - 341 - ua: trace protein 100 glucose 150 ketone, otherwise negative - urine hcg: initial ? + in ed, f/u hcg negative labs: 06:49am blood %hba1c-13.9* - lfts: alt - 59 ast - 100 ap - 113 ldh - 232 tbili - 0.1 amylase - 186 lipase - 406 triglycerids - 987 - lft trends: : amylase 201 lipase 273 triglycerides 469 - lft trends: : amylase 128 lipase 145 - ag trends: 0113 - 24 / 0257 - 20 / 022 - 17 / 1704 - 13 / 2130 - 12 0836 - 11 / 1621 - 12 / 0253 - 8 - abg trends: : 6.80/8/245 | 2217: 6.94/11/139 2332: 7.10/14/137 | 0536: 7.23/25/128 - glucose trends 1800 - 817, 2044 - 505, 0113 - 165 floor labs: 06:35am blood wbc-5.2 rbc-2.91* hgb-9.5* hct-27.8* mcv-96 mch-32.8* mchc-34.3 rdw-13.1 plt ct-218 06:35am blood glucose-231* urean-10 creat-0.6 na-139 k-3.8 cl-108 hco3-21* angap-14 06:35am blood alt-32 ast-37 alkphos-115 amylase-82 06:35am blood lipase-128 micro: stool culture () - negative urine culture - no growth, yeast >100,000 colonies blood culture x 2 - ngtd imaging: cxr - ap portable upright view of the chest: heart size is normal. the mediastinal and hilar contours are normal. there are low lung volumes producing crowding of the pulmonary vascular markings with no definite consolidation. costophrenic angles are sharp. there is no pneumothorax. impression - low lung volumes, no definite pneumonia ct abd/pel - 1. bilateral small pleural effusions. scattered subpleural ground glass opacities at the lung bases may represent evolving infectious etiology. 2. diffuse bowel wall thickening involving the distal transverse and sigmoid colon as well as the rectum consistent with colitis, likely infectious or inflammatory in etiology. no evidence of free intraperitoneal air or pneumatosis. 3. large amount of low-attenuation ascites within the abdomen. anasarca noted within the soft tissues. ecg: - sinus tachycardia. borderline low qrs voltage in limb leads. diffuse non-diagnostic repolarization abnormalities. prolonged qtc interval. no previous tracing available for comparison. - sinus tachycardia. compared to previous tracing multiple abnormalities persist without major change. brief hospital course: 1. diabetic ketoacidosis . in the ed, no temperature was documented, initial hr 118 bp 105/70 rr 22 o2 sat 100% 2l. initial blood glucose was found to be 817, w/ signifant ag of 32, hco3 of 2, k+ 5.3. ua was notable for 1000 glucose and 150 ketones. initial blood gas showed a ph 0f 6.79. in the ed, she was given 5units regular insulin iv and was started on a 5units/hour drip. she was administered a total of 7l ns prior to her transfer to the icu. in the , the insulin drip was continued and titrated up (as far as 14units/hr) until her hourly fsbg's trended below 250, at which time d51/2ns was begun at 125cc/hr. a central line was placed to facilitate resuscitation and agressive electrolyte (potassium, phosphate, anbd magnesium) repletion. an a-line was begun for accurate bp monitoring and to trend abgs. it was decided to give 2 amps of bicarb due to a persistent ph of <7.0 despite relatively aggressive insulin therapy. by morning, ms. mental status had considerably improved. she felt pain in her abdomen and was still exhibiting kussmaul breathing, but was no longer confused as an admission. am labs revealed a closing ag but significant hypernatremia and hyperkalemia, prompting a switch to d5w for resuscitation. k and phos continued to be aggressively repleted. her anion gap closed and bicarb increased over and , with some mild persistent hyperchloremic metabolic acidosis. recs, ms. was left on an insulin drip on and until the anion gap was < 12. she felt considerably improved on , at which time her central and a-lines were d/c'ed and her diet was advanced. she was begun on an insulin regimen of 20 units lantus the morning of as well as a humalog sliding scale. she was transferred to the medical floor on the night of . on the morning of , she was re-evaluated by the service and her lantus was increased to 24 units and her sliding scale covered tightened. 2. abdominal infection / colitis. the patient had been complaing of abdominal symptoms (nausea & diarrhea) for about 2 days prior to admission. her initial labs showed an elevated wbc count. cxr to verify line placement showed an extremely large air-filled stomach worrisome for potential obstruction - her stomach was decompressed by ng tube placement. given concern for infectious trigger of abdominal origin, lfts and a diff were ordered for , revealing a left shift as well as elevated pancreatic enzymes & triglycerides. the patient also continued to complain of lower abdominal pain. these studies were concerning for pancreatitis or other occult abdominal infeciton, prompting an abd/pelvic ct, which revelaed thickened colon c/w infectious vs. ischemic colitis. she was begun on an antibiotic regimen of ciprofloxacin and flagyl the evening of . she reported relief of abdominal symptoms and . cipro and flagyl were continued for a planned 7 day course. a bowel regimen was prescribed for continued constipation. she had a bowel movement on . on , she reported no difficulties with po intake. only minimal abdominal distention. no nausea or vomiting. 3. hypothermia the patient was hypothermic to ~91f both orally and axillary on admission to the in the setting of unrecorded ed temps and 7l of room temperature ns. a bair hugger was applied to her torso and lower extremities and warm blankets were provided. her temperature increased to 97.1f over the ensuing 3 hours. her temperature remained stable throughout her hospital course. . 4. gastroparesis. pt had known disgnosis of gastroparesis and pyloric stenosis. her stomach was greatly distended with air on presentation to the , decompressed w/ ng-tube. the patient complained of some nausea, and was treated with her home regimen of reglan. these symptoms improved prior to discharge. 5. ? uti. urine culture from grew >100k colonies of yeast with a ua that wasn't significantly positive for infection. pt reported no urinary symptoms, suggesting likely contaminant. 6. ? pregnancy. initial urine hcg in the ed reported to be positive. subsequent serum hcg and urine hcg in the were negative. . 7. family frustration. husband frustrated by pt's continued inability to care for herself. discussed the situation with social work and outpatient follow-up arranged. 8. prophylaxis. ppi, sc heparin, bowel regimen were given throughout pt's stay. 9. disposition. although patient's insulin regimen was titrated on the day of discharge and she did not have ideal glycemic control, she reported a strong desire to go home instead of staying in the hospital an additional day for further monitoring. she reported that she would comply with insulin and would call pcp or endocrinologist if fs were high. medications on admission: lantus (30u qam per omr pcp note on ) humalog (total of 30 to 45 units daily based on a sliding scale per omr note) reglan 5mg tid and hs ppi discharge disposition: home discharge diagnosis: diabetes mellitus, type i gastroparesis pyloric stenosis colitis (infectious vs inflammatory) discharge condition: afebrile, vital signs stable. discharge instructions: please take your insulin and all other medications as directed everyday. if you should feel ill, in particular feeling lethargic or have nausea or vomiting please return to emergency room or call your primary doctor. followup instructions: outstanding issues: 1) follow up culture data 2) titrate insulin to achieve improved glycemic control - dr. 9:00 am , rn 10:00 am ritholiz, social work 2:00pm provider: , md phone: date/time: 10:20 procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: hyperpotassemia other and unspecified noninfectious gastroenteritis and colitis personal history of noncompliance with medical treatment, presenting hazards to health hyperosmolality and/or hypernatremia diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled gastroparesis acquired hypertrophic pyloric stenosis 

Answer: The patient is high likely exposed to