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: morphine attending: chief complaint: nausea, vomiting major surgical or invasive procedure: none history of present illness: mr. is a 61yo m with esrd on hd (last hd yesterday) and af not on coumadin who presented from hus nursing home with vomitting and decreased po intake. he also endorsed sob and chest pain, which is reportedly chronic. pt denied hematemesis, dark stools, or brbpr. initially ed vitals t 98.5, hr 170, bp 103/89, rr 20, o2 sat 100%. he triggered for tacycardia. ecg showed afib with rvr. initially, the tacycardia was thought to be dehydration, and he was given 2l without improvement in his hr. tm in the ed 100.6; he got tylenol x1. cxr showed b/l opacities, concerning for pna vs volume. he was given vanc/levoflox. he was given boluses of dilt, followed by a drip. he briefly dropped pressures to 90s, came back up with slowing hr. other issues in the ed include a glucose of 50, for which he recieved d50. k was 5.8 on arrival. there were no pleaked t waves, and he was given calcium gluconate, insulin, and d50. he was hemodynamically stable upon transfer to the micu. of note, he was last admitted for afib with rvr leading to volume overload and respiratory distress requiring bipap on admission. he required hd for volume control. of note, patient has chads-2 score of 3, but is maintained on prophylaxis due to history of gi bleed. hyperthyroidism was thought to be contibuting to a fib last admission, and he was discharged on methimazole. his course was complicated by on , the patient first complained of new onset right lower extremity calf pain, followed by dense sensory loss of right foot late on with loss of plantar and dorsiflexion of ankle. neurology suspected compressive sciatic nerve neuropathy; mri of lumbar spine showed no evidence of mass or cauda equina syndrome. on the floor, pt is sleeping but arousable. past medical history: 1. esrd on hd t/th/sa at , , 2. type 2 diabetes mellitus c/b peripheral neuropathy 3. chronic systolic chf with ef 30% ( tte) 4. atrial fibrillation/aflutter - s/p ablation ; s/p ablation x 2 in - not on coumadin due to history of gibs. 5. hypertension 6. dyslipidemia 7. history of gi bleeds: duodenal, jejunal, and gastric avms s/p thermal therapy; diverticulosis throughout colon 8. chronic pancreatitis 9. ? hcv: hcv ab + , but neg 10. gerd 11. gout: s/p arthroscopy with medial meniscectomy 12. depression with multiple hospitalizations due to si 13. polysubstance abuse: crack cocaine, etoh, tobacco 14. recurrent chest pain following crack/cocaine use - no evidence cad on cath 15. erectile dysfunction s/p inflatable penile prosthesis 16. h/o c diff in social history: unable to reconcile - tobacco: smokes occassional cigarette; longterm smoking history > 42 pack years - etoh: reports last drink approx 5yrs ago, hx of abuse with associated withdrawal and dts requiring detoxification. - polysubstance abuse: repeat crack/ cocaine use; last 1 mth ago family history: per omr, unable to reconcile mother had esrd on hd, died from mi at the age of 58. 4 brothers and 2 sisters, nearly all with dm2 physical exam: admission physical exam: vitals: t: 97.8 bp:138/73 p: 111 r: 22 o2: 99% general: arousable, able to follow commands heent: sclera anicteric, mmm lungs: decreased breath sounds in the bases b/l cv: tacycardiac, irregularly irregular abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, no clubbing, cyanosis or edema . discharge physical exam: vitals: 98.4, 128/68, 92, 18, 94% ra gen: nad, awake and alert, sitting in wheelchair heent: eomi, mmm, sclera injected but anicteric cv: irregularly irregular, no mrg resp: ctab, no rales or wheeze abd: soft, nt, nd, + bs ext: warm, well perfused, no edema. fingers of right hand held in flexion. neuro: strength 4/5 in lle and rle, poor r foot dorsiflexion pertinent results: admission labs: 04:45pm blood wbc-8.1 rbc-3.72* hgb-11.5* hct-32.9* mcv-88 mch-30.8 mchc-34.8 rdw-15.1 plt ct-210 04:45pm blood pt-15.0* ptt-30.8 inr(pt)-1.3* 04:45pm blood glucose-54* urean-47* creat-7.6*# na-137 k-5.8* cl-95* hco3-27 angap-21* 04:45pm blood alt-22 ast-30 alkphos-174* totbili-0.7 04:45pm blood calcium-11.6* phos-5.9* mg-2.4 04:45pm blood t4-15.9* 05:04pm blood lactate-1.6 k-5.7* . discharge labs: 06:17am blood wbc-9.3 rbc-3.57* hgb-10.7* hct-31.5* mcv-88 mch-29.9 mchc-34.0 rdw-14.5 plt ct-303 05:35am blood glucose-291* urean-72* creat-6.1*# na-135 k-5.1 cl-96 hco3-24 angap-20 06:17am blood ck(cpk)-31* 06:30am blood alt-15 ast-14 alkphos-139* totbili-0.4 05:35am blood calcium-9.2 phos-3.2 mg-2.2 04:40pm blood t4-7.1 t3-105 free t4-1.9* 04:40pm blood tsh-<0.02* . microbiology: blood cultures (): negative . ekg: : probable atrial flutter with 2:1 a-v conduction with an atrial rate of about 320 and a ventricular rate of about 160. poor r wave progression. non-specific st-t wave changes. low qrs voltage in the limb leads. compared to the previous tracing of rapid atrial flutter is present. . : atrial fibrillation with controlled ventricular response. since the previous tracing the rate slower. . : atrial fibrillation with rapid ventricular response. borderline low limb lead voltage. st-t wave abnormalities. since the previous tracing of the rate is faster. otherwise, findings are unchanged. . imaging: cxr (): impression: low lung volumes with patchy opacities in the lung bases which may reflect atelectasis, though infection cannot be excluded. mild pulmonary vascular congestion. . arterial study of lower extremity (): normal triphasic doppler waveforms were acquired in the common femoral arteries bilaterally. the doppler waveform at the right popliteal, posterior tibial, and dorsalis pedis is monophasic. the doppler waveform at the left popliteal artery is still triphasic with monophasic waveform at the posterior tibial artery and dorsalis pedis. the abi index on the right 0.58 and abi index on the left is 0.85. the pulse volume recordings are symmetrical. impression: moderate outflow disease on the right at the level of superficial femoral artery and posterior tibial artery and mild outflow obstruction at the level of left posterior tibial artery. . lower extremity ultrasound (): impression: no dvt in the right lower extremity. brief hospital course: 61yo m with dm, esrd on hd, af, schf (ef 30%), and hyperthyroidism who presents from rehab with nausea and poor po intake found to be in af with rvr. . # atrial fibrillation with rvr: rates to 170s initially. received 2l of fluids in the ed without improvement in hr. he was given dilt boluses in the ed followed by gtt and transferred to micu. he had a transient hypotension to the 90s (sbp) in the setting of rate and dilt gtt, however his pressures improved with slowing his rate. he is not anticoagulated with coumadin given history of gib; on full-dose . his rate slowed to the 80s-90s and he was taken off of the dilt gtt and started on diltiazem 90mg q6h. had an admission 2 weeks ago where hyperthyroism / thyrotoxicosis was felt to be contributing to tachycardia. his tsh remained <0.02, and endocrine was reconsulted (see below). his rate control improved with treatment of thyroid disease. he was able to be transtioned to diltiazem er 360mg daily with good control of heart rate. his heart rates were in the 90s at the time of discharge. . # amiodarone induced hyperthyroidism, likely type ii. endocrine consulted for management. patient was started on methimazole 20mg as well as prednisone 40mg for combined control of likely type 2 amiodarone induced hyperthyroidism. patient's t4 was initially elevated at 15.9, but decreased over 6 days to 9.7. additionally, his free t4 and t3 also decreased during the hospitalization. his tsh remained suppressed. patient was subjectively improved with these changes. his doses were slowly downtitrated to 20mg of methimazole and 20mg prednisone prior to discharge. started on bactrim prophylaxis given prolonged course of prednisone. . # esrd: tues/thurs/sat hd. team notified of admission via email. evaluated and maintained on his outpatient schedule. cinacalcet was uptitrated. . # chest pain: initially complained of chest pain in the ed, resolved by the time of icu transfer without recurrence. his troponin is elevated chronically in the setting of renal failure. no st changes noted on ecg. he was continued on aspirin. no further chest pain. his home statin was discontinued out of concern for contribution to generalized muscular pain. . # hypoglycemia: hypoglycemic in the ed and during the first few days of his stay, likely in the setting of poor po intake and lantus. initially held home standing lantus and covered with humalog sliding scale coverage. endocrinology assisted in the adjustment of his sliding scale and basal insulin. . # htn: on diltiazem and lisinopril. the dose of lisinopril was reduced due to concerns of previous episodes of hyperkalemia. . # myalgias: improved with ambulation, likely related to position/deconditioning. atorvastatin stopped given concern for statin induced rhabdo, although ck was normal. if myalgias don't improve, can consider restart of atorvastatin, although most recent ldl was 51. . # hyperlipidemia: atorvastatin held as above, consider restart as outpatient. . # diabetes: continued on glargine with sliding scale. sliding scale uptitrated while in hospital, likely will need further titration. . #foot pain: likely multifactorial, with component of neuropathy. however patient also described claudication symptoms. abis were obtained and were abnormal. outpatient vascular surgery follow up arranged. # transitional issues - f/u with endocrinology, vascular surgery - t/th/sat - consider restarting atorvastatin based on ldl/improvement of myalgias medications on admission: 325mg atorvastatin 20mg lisinopril 20mg cinacalcet 30mg senna pantoprazole 40mg daily nephrocaps daily neurontin 300mg daily methimazole 20mg tab daily dilt 30mg 5 tabs qid albuterol 2 puffs q6 prn/albuterol nebs prn sevelamer 4 tabs tis with meals benadryl 25mg 1-2 tabs q8 prn lantus 16 units lispro sliding scale oxycodone-acetaminophen 5/325 discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. cinacalcet 30 mg tablet sig: three (3) tablet po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob, wheeze. 7. sevelamer carbonate 800 mg tablet sig: four (4) tablet po tid w/meals (3 times a day with meals). 8. lantus 100 unit/ml solution sig: twenty four (24) units subcutaneous at bedtime. 9. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous qachs. 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 11. methimazole 10 mg tablet sig: two (2) tablet po daily (daily). 12. prednisone 10 mg tablet sig: two (2) tablet po daily (daily). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 14. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 15. diltiazem hcl 180 mg capsule, extended release sig: two (2) capsule, extended release po daily (daily). 16. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 17. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 18. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): to right leg 12 hours on, then 12 hours off. 19. polyethylene glycol 3350 17 gram powder in packet sig: one (1) packet po once a day as needed for constipation. discharge disposition: home with service facility: healthcare center - discharge diagnosis: primary: amiodarone induced hyperthyroidism - type 2, atrial fibrillation, end stage renal disease, diabetes, peripheral vascular disease secondary: hypertension, drug abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was our pleasure caring for you at you were admitted for a rapid and irregular heart rate, called atrial fibrillation. you also had been experiencing nausea and had not been eating normally. on admission, you were found to have high thyroid levels, a hormone that regulates the body's functions. high thyroid levels can lead to a rapid heart rate among other symptoms. . our endocrinology team saw you and started treatment for your high thyroid levels. they will continue to follow you as an outpatient. our renal team saw you to continue your hemodialysis and ensure your fluid and electrolytes were well-managed. we were able to control the rapid heart rate with iv medications, then transitioned to oral medications. . we made the following changes to your medications: stopped: benadryl percocet atorvastatin - this medication was stopped as you were having muscle pains which is a side effect of the medicine. if your symptoms do not improve, then we would recommend restarting this medicine after discussions with your doctors. changed doses - lisinopril reduced to 10mg daily - diltiazem increased to 360mg er daily - lantus increased to 24 units each evening - insulin sliding scale increased by 3 units per level at lunch and dinner - cinacalcet increased to 90mg daily - sevelamer increased to 3200mg tid with meals started: - tylenol 325-650mg every 6 hours as needed for pain - docusate 100mg twice a day for stool softening - lidocaine 5% patch for leg pain. apply for 12 hours, then off for 12 hours - prednisone 20mg daily for thyroid - bactrim ss 1 tablet daily to prevent infection while on prednisone - methimazole 20mg daily for hyperthyroidism weigh yourself every morning, call your primary care physician if weight goes up more than 3 lbs. please take all your medications as directed. please follow-up with your physicians at the planned appointments listed below. your regular schedule will continue. followup instructions: please attend the following appointments: department: medical specialties when: wednesday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: vascular surgery when: thursday at 3:30 pm with: , md building: lm bldg () campus: west best parking: garage procedure: hemodialysis diagnoses: hyperpotassemia end stage renal disease renal dialysis status tobacco use disorder congestive heart failure, unspecified atrial fibrillation polyneuropathy in diabetes depressive disorder, not elsewhere classified alcohol abuse, unspecified cocaine abuse, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease nausea with vomiting constipation, unspecified other and unspecified hyperlipidemia hypotension, unspecified chronic systolic heart failure accidents occurring in unspecified place chest pain, unspecified diabetes with neurological manifestations, type ii or unspecified type, uncontrolled cervicalgia cardiac rhythm regulators causing adverse effects in therapeutic use pain in limb thyrotoxicosis of other specified origin without mention of thyrotoxic crisis or storm pain in joint, multiple sites 

Answer: The patient is high likely exposed to