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: section 12 for /hyperkalemia. major surgical or invasive procedure: hemodialysis history of present illness: the patient is a 31 y.o male with dm1, esrd on hd, reportedly on the list who presents again with hyperkalemia after missing hd. pt reportedly not cooperative in the ed and agitated. of note, pt has had several admissions for hyperkalemia/missing hd sessions and left the hospital ama including most recently on . during pt's most recent admission/ed visit pt reported lle swelling, lenis negative and pt was given unasyn. given pts multiple ama's and noncompliance with hd and medical treatment, pt's outpt hd sw feels that pt has an underlying psychiatric disorder that makes him incompetent to make medical decisions. therefore, plan (developed by outpt renal dr. and sw)was to section the pt for hd and psychiatric eval. psychiatry saw pt in the ed, feels that he lacks competency and suggests that the medical team pursue legal guardianship. in addition, pt often states that he is taking drugs and drinking large quantities of etoh and withdrawing in the hospital, but tox screens are negative. in the , pt refused kayexylate, ekg. pt was given haldol 5mg iv and ativan 2mg iv. renal fellow aware that pt is here and hd planned for tonight. ekg showing ?some peaked t's. no intervention for hyperkalemia given plan for hd. time pain temp hr bp rr pox 17:43 9 99.6 106 192/92 18 100 states drinking a liter of etoh daily. past medical history: 1. type i dm (diagnosed 13 years ago), managed by dr. 2. esrd: ckd stage 5 (on hemodialysis since ) t-t-s recently, he has been mostly dialyzed in hospital, but usually gets his hd at in t,th,sat. 3. diabetic retinopathy (diagnosed 2 years ago) 4. diabetic neuropathy 5. diabetic myonecrosis () 6. chronic ulcer at right foot 7. hypertension 8.?psychiatric disorder-bipolar social history: recent social situation complicated, in that patient used to live with his mother, but due to a disagreement, has moved out. smokes, unclear amount. his of recent "dope" use. also reports etho use, but unclear amounts. family history: his family history is significant for diabetes. his mother and his father are in the 50's both suffering from dmii. he has 2 sisters at the age of 20 and 26 both suffering from dmi. he has four brothers at the age of 16, 19, 28, and 30. his both older brothers suffer from dmi. all his grandparents had dm. pt. says ther is no h/o of heart disease, htn, cancer or bleeding disorders in the family. physical exam: on admission: gen-somnolent after sedation, arousable to painful stimuli, snoring. vitals-t. 96.9, hr 97, bp 178/88, rr 13, sat 96% on ra heent-perrla, eomi, anicteric,mmm, neck-unable to assess for jvp, no lad chest-b/l ae, transmitted upper airway noise, no wheezing/crackles heart-s1s2 rrr no m/r/g abd-+bs, soft, nt, nd ext-lle 3+pitting edema to mid-thigh with splotchy erythema. 2+dp/pt pulses. rle trace edema, 2+pulses. no calf tenderness or cords. neuro-somnolent but moving all 4 extremities. pertinent results: labs on admission: 06:55pm blood wbc-11.8* rbc-3.81* hgb-10.3* hct-31.4* mcv-82 mch-27.1 mchc-32.8 rdw-17.3* plt ct-456* 06:55pm blood neuts-80.7* lymphs-12.2* monos-3.9 eos-3.1 baso-0.1 06:07am blood pt-13.1 ptt-26.4 inr(pt)-1.1 06:55pm blood glucose-107* urean-73* creat-12.0*# na-136 k-6.4* cl-94* hco3-25 angap-23* 06:07am blood alt-29 ast-26 ld(ldh)-321* alkphos-109 totbili-0.4 06:07am blood albumin-3.6 calcium-8.1* phos-5.9* mg-2.2 06:55pm blood -neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg other labs 03:17pm blood wbc-15.1* rbc-3.18* hgb-8.3* hct-26.6* mcv-84 mch-26.1* mchc-31.2 rdw-17.5* plt ct-457* 06:30am blood wbc-9.2 rbc-3.17* hgb-8.4* hct-26.8* mcv-84 mch-26.4* mchc-31.2 rdw-18.0* plt ct-524* 03:17pm blood pt-14.8* ptt-26.9 inr(pt)-1.3* 06:40am blood glucose-152* urean-38* creat-5.4* na-132* k-5.6* cl-93* hco3-28 angap-17 03:53am blood alt-288* ast-302* ld(ldh)-405* ck(cpk)-157 alkphos-272* totbili-0.4 10:30am blood alt-182* ast-91* ld(ldh)-261* alkphos-277* totbili-0.3 07:51pm blood ck-mb-4 ctropnt-0.31* 07:50am blood ck-mb-4 ctropnt-0.31* 03:53am blood ck-mb-3 ctropnt-0.27* 06:30am blood calcium-8.5 phos-4.2 mg-2.5 07:10am blood vitb12-761 07:10am blood tsh-1.2 03:53am blood -neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 12:15am blood type-art po2-35* pco2-50* ph-7.37 caltco2-30 base xs-1 12:15am blood glucose-87 lactate-0.8 na-134* k-6.8* cl-94* 06:55pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 06:55pm urine blood-tr nitrite-neg protein-500 glucose-1000 ketone-neg bilirub-neg urobiln-neg ph-8.0 leuks-neg 06:55pm urine rbc-0-2 wbc- bacteri-none yeast-none epi-0-2 06:55pm urine color-yellow appear-clear sp -1.012 rapid plasma reagin test (final ): nonreactive. reports- echo- the left atrium is normal in size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef 80%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is mild mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. ct pelvis impression: 1. no evidence for venous thrombosis in the bilateral iliac vessels or ivc. 2. vascular calcifications, greater than expected for a patient of this age, likely reflecting history of diabetes. 3. within the limits of non-contrast and delayed phase imaging, no acute pelvic pathology. le doppler impression: no left leg dvt. le doppler impression: no evidence of dvt of the left lower extremity. le doppler impression: no evidence of left lower extremity dvt. left knee, three views there is deformity and increased density in the right tibial plateau consistent with a tibial plateau fracture, with depression. there is a probable joint effusion. there is minimal spurring about the patella. there is an ossific fragment along the medial border of the patella, which appears well corticated, and which could represent a either fracture fragment or heterotopic ossification in the medial retinaculum. no dislocation is identified. dense vascular calcification is noted. impression: 1) findings consistent with medial tibial plateau fracture likely subcaute or chronic . 2) ossicle along medial patella -- ? nonacute fracture vs post- traumatic heterotopic ossificaiton in adjoining medial retinaculum. possible subacute fracture along the medial patella. 3. joint effusion. ekg cardiology report ecg study date of 10:25:34 am normal sinus rhythm. j point elevation consistent with normal early repolarization. otherwise, within normal limits. compared to the previous tracing of previous non-specific st-t wave abnormalities have resolved. otherwise, no important change. clinical correlation and repeat tracing are suggested. read by: , intervals axes rate pr qrs qt/qtc p qrs t 87 152 88 356/403 61 17 53 ct knee impression: 1. depressed, impacted medial tibial plateau fracture which also extends to the intercondylar eminence and medial tibial spine. 2. medial patellar fracture. 3. moderate to large knee joint effusion brief hospital course: 31 year-old male with esrd on hd, dmi, htn presented with hyperkalemia in context of missing hemodialysis. he was section 12. initially went to micu for hd, then transferred to floor for continued hd. had return to micu later in hospital course for more intensive hd treatment secondary to hypoxia and fluid overload. first micu course: patient was dialyzed twice, with approximately 10l taken off during both episodes. patient was having a manic episode and was given haldol prior to being called out to the floor. hypoxia resolved with and patient was placed on fluid restriction of 1l. ambulatory and talkative on discharge to the floor. 1. chronic renal failure-secondary to esrd/dm: the patient is on hd tue/thurs/sat, and had missed hd sessions. has hypertension, hyperkalemia, and hyperphosphatemia, and so hd was initiated in the icu. received hd on 3 consecutive days, and then switched back to t/th/sat schedule. was continued on home regimen of cinacalcet, lanthanum, calcium acetate, nephrocap. on , pt had acute hypoxia requiring non-rebreather mask. improved with lasix, but still unable to be off non-rebreather. was transferred to micu for 2 days for emergent hd. sx resolved with fluid removal. hypoxia resolved. now on m, w, f schedule. started on lasix 80mg po by renal and fluid restriction of 1.5 liters per day with low salt diet. 2. left lower extremity edema/tibial fracture: started appx about a week before admission. patient initially denies pain with ambulation or knee joint manipulation. had three negative sets of lower-extremity dopplers and a pelvic ct to rule out dvt. patient was on antibiotics at presentation, but this is not consistent with a cellulitis. and was briefly back on abx during transfer to micu after had a fever for one day up to 100.8. pt later began complaining of more knee than leg pain and xray showed tibial plateau fracture and small patella fracture. pt reported falling on concrete before admission. orthopedics was consulted and were considering surgical repair. under anesthesia knee was examined after ct was obtained. opted for conservative medical treatment with knee brace and crutches. is touch down wt bearing on left leg with ortho follow up. 3. psychiatric: the patient has a persistent pattern of non-compliance with hd, leaving ama. out pt hd sw concerned re: psychiatric process such as bipolar disorder or similar leading to non-compliance. at this time, sw and pt's out pt nephrologist have decided to section 12 pt. psychiatry evaluated patient and agreed he does not have capacity and the medical team should consider guardianship. had episodes of threatening to leave hospital on admission requiring chemical restraints (5 mg haldol and 2 mg lorazepam each episode). psychiatry followed the patient and 1:1 observation was maintained. was initially on iv haldol, then transitioned to po 2mg plus prn 1mg doses. ekg was monitored without qtc prolongation. will need further titration after discharge to psych . in process of started guardian paperwork to establish his mother as guardian. 4. increase in size of cardiac silhouette by cxr on : the patient was ruled out for pericardial effusion by echo. most likely projection artifact. 5. hypertension: he was restarted on his medications amlodipine, lisinopril, labetolol. metoprolol held given no clear indication to be on two beta-blockers. 6. diabetes mellitus type 1: insulin 75/25 at half of home doses and conservative sliding scale insulin given that patient was taking little orally at first. then changed to labetalol at bedtime due to better compliance. sliding scale was later increased due to increase po intake. 7. reported etoh: patient states drinking 1l of etoh daily. tox negative for etoh at admission. no history of withdrawal symptoms, however he was monitored for such. 8. lateral twave changes: on transfer to the , patient was noted to have twi in leads i, avl, v4-6. cardiac biomarkers were flat, and patient was asymptomatic. repeat ekg showed some resolution of twi. given his multiple risk factors for cad, he was started on aspirin. he was continued on beta-blocker and statin as above. plan to discharge to psych facility for further care. will have pcp and orthopedic follow up and continued hd on m/w/f. medications on admission: **patient unable to provide. per discharge summary on ... calcium acetate 667mg, 2 capsule po tid w/meals metoprolol tartrate 25mg tablet, 1 tablet po bid simvastatin 40mg tablet, 2 tablet po daily insulin lispro 100 unit/ml solution : one (1) subcutaneous asdir sensipar 30mg tablet, 1 tablet po once a day lanthanum oral medications on transfer: bisacodyl 10mg po/pr daily:prn senna 1 tab po bid:prn docusate sodium (liquid) 100mg po bid heparin 5000 unit sc tid famotidine 20mg po q24h atorvastatin 40mg po daily lorazepam 0.5-2mg iv q4h:prn agitation; hold for resp depression epoetin alfa, to be administered during and dosed according to the epoetin alfa p&t guidelines cinacalcet 90mg po daily lanthanum 1000mg po qid with meals/snack lisinopril 40mg po daily hold for sbp <100 amlodipine 5mg po daily hold for sbp <100, hr <55 calcium acetate 1334mg po tid w/meals labetalol 300mg po tid hold for sbp <100, hr <55 metoprolol succinate xl 25mg po daily hold for sbp <100, hr <55 nephrocaps 1 cap po daily hydralazine 10mg iv q6h:prn for sbp >160, if not tolerating po metoprolol tartrate 5mg iv q6h:prn for sbp >160 if not tolerating po humalog 75/25 10 units qam, 8 units qpm humalog sliding scale insulin haloperidol 5 mg iv q1h:prn agitation please notify house staff if giving in consecutive hours. discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. epoetin alfa 10,000 unit/ml solution : one (1) injection asdir (as directed): with hemodialysis. 3. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 4. methyl salicylate-menthol 15-15 % ointment : one (1) appl topical qid (4 times a day) as needed for knee pain. 5. cinacalcet 30 mg tablet : one (1) tablet po daily (daily). 6. valsartan 160 mg tablet : one (1) tablet po once a day. 7. diphenhydramine hcl 12.5 mg/5 ml elixir : po hs (at bedtime) as needed for insomnia. 8. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 9. amlodipine 5 mg tablet : one (1) tablet po daily (daily). 10. haloperidol 1 mg tablet : two (2) tablet po q 12h (every 12 hours). 11. labetalol 300 mg tablet : one (1) tablet po three times a day. 12. folic acid 1 mg tablet : one (1) tablet po daily (daily). 13. calcium acetate 667 mg capsule : two (2) capsule po tid w/meals (3 times a day with meals). 14. aspirin 325 mg tablet : one (1) tablet po daily (daily). 15. nicotine 21 mg/24 hr patch 24 hr : one (1) patch 24 hr transdermal daily (daily). 16. atorvastatin 40 mg tablet : one (1) tablet po at bedtime. 17. haloperidol 1 mg tablet : one (1) tablet po q2h (every 2 hours) as needed for agitation. 18. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 19. lanthanum 500 mg tablet, chewable : two (2) tablet, chewable po qid (4 times a day). 20. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 21. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 22. insulin glargine 100 unit/ml solution : sixteen (16) units subcutaneous at bedtime. 23. famotidine 20 mg tablet : one (1) tablet po q24h (every 24 hours). 24. humalog 100 unit/ml solution : one (1) unit subcutaneous before meals and at bedtime: please follow sliding scale provided. 25. furosemide 80 mg tablet : one (1) tablet po daily (daily). discharge disposition: extended care facility: 4 discharge diagnosis: primary: - hyperkalemia - end-stage renal disease, on hemodialysis - tibial plateau fracture and patella fracture - agitation and poor compliance with secondary: - diabetes mellitus, type i - hypertension discharge condition: hemodynamically stable, afebrile, ambulating with crutches and knee brace with touch down weight bearing discharge instructions: you were admitted to the micu on for high potassium level in context of not going to . you were dialyzed in the icu. you were also given sedating medications due to agitation. you had an investigation of the swelling in your left leg. you did not have a blood clot. you underwent a xray of your leg confirming the fracture, you were given crutches and a knee brace. you should not bear weight on your knee until your follow up appointment with the orthopedic clinic. your medication regimen has changed. please review your medication list closely. please be sure to follow-up with your providers as listed below. please be sure to follow-up with all treatments. you will now have on mon, wed, and fri. please return to the emergency department or call your physician for chest pain, shortness of breath, palpitations/heart fluttering, fever, worsening swelling of your leg, or for any other symptoms which are concerning to you. followup instructions: pcp: , . , please call for a follow up appointment once you are discharged from the psychiatric facility. othopedics: dr. , appointment on thursday, at 11:30am. your appointment is located in the building, . call with questions. : continue on monday, wednesday, and friday. procedure: hemodialysis diagnoses: hyperpotassemia end stage renal disease tobacco use disorder polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease closed fracture of patella hypoxemia alcohol abuse, continuous fall from other slipping, tripping, or stumbling closed fracture of upper end of tibia alone background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled effusion of joint, lower leg bipolar i disorder, most recent episode (or current) manic, unspecified 

Answer: The patient is high likely exposed to