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: a.c.e inhibitors attending: chief complaint: cardiac arrest, transferred from osh for cooling major surgical or invasive procedure: intubation bronchoscopy with removal of foreign body left subclavian line placement arterial line placement history of present illness: 50yo m with history of possible diabetes and hepatitis c found down by ems in asystole with low bs. (possibly surrounding drug paraphenalia). fs glucose = 46 in the field. he was intubated and given d50, epinephrine and atropine. he developed vfib and was defibrillated x 1 and resumed sr. he presented to osh ed in bradycardia and given more atropine. in the pt given amiodarone drip 1mg/min, dopamine drip, asa, versed for sedation. repeat fs=86 and given add'l d50. lactate 6.3. tox negative. head ct showed occipital hematoma, he was boarded and collared. ogt placed. no foley cath placed given hypospadia. pt was transferred from osh () to for cardiac arrest hypothermia protocol. vital on transfer: bp 120s, hr70, o2sat99% on 100%fio2. osh labs: tot bili 0.7, alkph=48, ast=53, ck=560, mb=11.1, trop=?, valproic acid level=41, etoh<10, neg barbiturate, neg benzo, ne antidepressant, . of note, pt was recently hospitalized at for hypoglycemia with similar presentation fs=17. family raised question of possibly pt leaving ama. on u-500 insulin. pt found down in field and admitted for management of glucose levels. . on admission to , he was placed on arctic sun protocol with rectal and esophageal temp probe. started on fentanyl gtt and versed gtt, and vecuronium 10mg iv push. temp 91.0 rectal after cooling initiated in ed. r groin triple lumen line placed and pt admitted to ccu for further management. . on the floor, pt continued on arctic sun protocol s/p arrest. arteria line was placed. pt hemodynamically stable on telemetry monitoring and continued intubation, sedation, paralytic. family informed of clinical status; sister identified herself as closest living relative. past medical history: 1) hypertension 2) diabetes mellitus (on u-500 insulin) - recent hospitalization at for hypoglycemia 3) diabetic retinopathy 4) bipolar disorder 5) chronic back pain 6) right eye blindness 7) hyperkalemia from ace-inhibitor 8) depression 9) bilateral cataracts social history: social history: unmarried, unemployed -tobacco history: unknwn -etoh: -illicit drugs: family history: unknown physical exam: physical examination on admission: general: intubated obese caucasian male, sedated wearing c-collar heent: small abrasion on r forehead; anisocoria r>l pupil size neck: cervical collar in place cardiac: very distant heart sound, no apparent m/r/g. no thrills, lifts. lungs: no chest wall deformities, scoliosis or kyphosis. ventilated. anterior exam only - some crackles noted on r lung exam. abdomen: soft, obese. no hsm or tenderness. bs noted. extremities: +edema in all extremities, nonpitting gu: very small penis with inferior pinpoint urethral meatus skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ . physical exam on day of discharge: pertinent results: labs: xxxxxxxxx . studies: ecg study date of sinus rhythm with first degree atrio-ventricular conduction delay. non-specific qrs widening. tented t waves in the anterior precordial leads. consider hyperkalemia. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 64 /479 24 67 9 . chest (portable ap) study date of findings: in comparison with the study of , the tip of the endotracheal tube is at the upper clavicular level, approximately 6.8 cm above the carina. nasogastric tube again extends into the stomach. mild enlargement of the cardiac silhouette persists. there is again an area of hazy opacification involving the upper portion of the left lung. this raises the possibility of contusion or possible pneumonia. volume loss in the left upper lobe could also be considered. right lung is clear. . abdomen (supine only) port study date of findings: single view fails to show the uppermost portion of the abdomen and the course of the nasogastric tube. there is a virtually gasless abdomen except for some gas within the colon. although there is no evidence of obstruction, if there is serious clinical concern for dilated, fluid-filled loops of bowel, ct would be necessary to definitely exclude an obstruction. . ecg study date of sinus rhythm. right axis deviation is non-specific but cannot exclude left posterior fascicular block or possible right ventricular overload. delayed r wave progression with late precordial qrs transition. borderline prolonged qtc interval. findings are non-specific. clinical correlation is suggested. since the previous tracing of further right axis deviation is present. intervals axes rate pr qrs qt/qtc p qrs t 82 178 92 9 31 . chest (portable ap) study date of impression: 1. findings concerning for left upper lobe collapse and central/mediastinal adenopathy. recommend further evaluation with ct to evaluate for underlying malignancy. this was discussed with dr. and at the time of approval a contrast enhanced ct had been requested. 2. interval repositioning of swan which is now terminating in the proximal right lobar or distal right main pulmonary artery. 3. deep left subclavian catheter extending into the right atrium, withdrawal by 5 cm to position at the cavoatrial junction is recommended. . ct head w/o contrast study date of findings: there is no evidence of hemorrhage, infarct, mass, mass effect or edema. there is diffuse sinus disease with mucosal thickening of the bilateral maxillary, ethmoid and sphenoid sinuses as well as the mastoid air cells. there is calcification seen in the petrous portion of the right internal carotid artery. there are no fractures seen. impression: extensive sinus disease. carotid artery calcifications. . ct c-spine w/o contrast study date of findings: visualization below c7 is limited by artifact from an endotracheal balloon. no fracture of the cervical spine is seen. there is mild degenerative disease with a bridging osteophyte seen at c3-c4 level. calcifications of the left and right carotid arteries are seen. there are no soft tissue abnormalities in the prevertebral and paravertebral spaces. endotracheal tube and orogastric tube are seen within the trachea and esophagus respectively. impression: exam limited below c7. no cervical spine fracture seen. calcified internal carotid arteries. . ct chest w/contrast study date of findings: obstruction of the left main bronchus, approximately 4.2 cm from the carina si by a lesion of low density, approximately 50 hounsfield units tissue. the left upper lobe is completely collapsed with a low-density material seen in the bronchi (the appearance of "drowned lung"). the rest of the tracheal and bronchial tree is patent throughout. there is left hilar lymphadenopathy, 2:27, approximately 1.5 cm in diameter. the aorta is unremarkable. main pulmonary artery is dilated up to 4 cm, finding that might be consistent with pulmonary hypertension. the mediastinum is shifted to the left due to the left upper lobe collapse. the left lower lobe is expanded till the apex with the superior segment of the left upper lobe being located in the apex posterior to the collapsed left upper lobe, luftsichel sign. the heart size is minimally enlarged. there is no pericardial effusion. the swan-ganz catheter tip is in right lower lobe pulmonary artery and to secure its position in the main pulmonary artery should be pulled back approximately 8 cm. the imaged portion of the upper abdomen demonstrates moderate to significant splenomegaly and otherwise is unremarkable within the limitations of this study that was not designed for evaluation of intra-abdominal pathology. the ng tube tip is in the stomach. the et tube tip is approximately 5 cm above the carina. the right upper lobe and the right middle lobe are grossly unremarkable. right lower lobe posterior opacities most likely consistent with aspiration combined with atelectasis. infectious process, although cannot be excluded, is less likely. left lower lobe area of atelectasis is noted posteriorly as well. there are no bone lesions worrisome for infection or neoplasm. impression: 1. complete collapse of left upper lobe as described in detailed. evaluation of the patient with bronchoscopy is highly recommended for therapeutic and if necessary diagnostic purposes since the obstruction might be either mucous plug or endobronchial neoplasm (less likely but cannot be entirely excluded). 2. right lower lobe posterior opacity most likely a combination of atelectasis and aspiration. 3. slightly too distal position of the tip of the swan-ganz catheter in the right lower lobe pulmonary artery. 4. mild cardiomegaly. . chest (portable ap) study date of findings: left upper lung veil-like opacity is stable in appearance dating back to exam. this finding corresponds to left upper lobe collapse as demonstrated on ct chest of . hilar, mediastinal and cardiac silhouettes are stable. no pleural effusions, pulmonary edema or pneumothorax. et tube is 6 cm from the carina. swan-ganz catheter tip projects over proximal right pulmonary artery. ng tube is within non-distended stomach, tip out of view. impression: persistent left upper lobe collapse. . chest (portable ap) study date of findings: there is an og tube with the tip in the proximal stomach. the proximal port is at the gastroesophageal junction. there is patchy left lower lobe volume loss in the retrocardiac region. there is a left subclavian line with tip in the svc. the et tube is in similar location to prior. there is a small right effusion. brief hospital course: pt is a 50yo caucasian male with h/o dm, recent hospitalization for hypoglycemia, htn, bipolar do, found down in the field with fs=46 and pea arrest. he was given d50 and pt went into vfib arrest. pt defibrillated and no st elevations on ekg noted. he was intubated, and transferred to from osh for cooling s/p cardiac arrest. . cardiac arrest: patient was found to be hypoglycemic at the time w/fs of 46. hypoglycemic and toxicology etiologies were considered. tox screen was within normal limits. ekg at osh showed no st segment elevations; cardiac enzymes were initially elevated ce at osh (likely secondary to arrest) and trended downward. he was cooled per arctic sun cooling protocol and antiarrhythmic therapy with amiodarone was used. dopamine drip was used for bp support. echo was performed to eval for structural abnormalities which showed small, thick-walled left ventricle, lvef 70-75%. chest xray suggested left upper lobe collapse, however ct of chest was defered because pt was on cvvh. renal status improved and pt was able to come off cvvh for ct of head, c-spine and chest. head and spine ct showed no fracture or acute intracranial process. however, chest ct showed an obstruction of the left main bronchus, approximately 4.2 cm from the carina by a lesion of low density; the left upper lobe was completely collapsed with a low-density material seen in the bronchi (the appearance of "drowned lung"). therapuetic and diagnostic bronchoscopy was recommended and performed which revealed that the patient had aspirate an insulin cap. per family, pt was in the habit of biting of the top of insulin pen prior to injection. it was hypothesized that the patient inhaled and choked on the insulin cap and in the process injected himself with insulin becoming both hypoxic and hypoglycemic, causing the pea arrest. . hypoglycemia: most likely contributed to pea arrest. noted recent difficulty managing blood glucose levels, with recent admission to hospital for hypoglycemic episode. dm managed on u-500 insulin and probable cause for hypoglycemia. blood glucose was closely monitored, hypoglycemia was corrected during admission. recommendation pt was placed on insulin drip for glucose management and then transitioned to regular iss. after extubation, the patient was seen by speech and swallow and his diet was slowly advanced. pt has outpt endocrine/ follow-up for continued management of his dm2 after discharge. . pneumonia: upon admission, there was concern for pneumonia (?aspiration) as he was found down in the field, chest xray findings were initially suggestive of infiltrate, and he was showing signs of sirs. he was intially started on vancomycin and levofloxacin, then transitioned to vancomycin and unasyn due to concern for anaerobic bacteria. blood cultures came back negative. patient continued to have fevers despite antibiotics, however fevers stopped after the insulin cap was removed, indicating he was likely having a localized inflammatory response to the foreign body obstruction rather than vap. antibiotics were stopped after cap was removed. respiratory failure: pt was unable to protect airway in setting of vfib arrest and collapse of lul secondary to aspirated insulin cap. we had trouble weaning him from the ventilator secondary to agitation. however, on his sedation was turned off and he was successfully extubated. renal failure: unclear creatinine baseline. acute injury possible secondary to poor cardiac forward flow in setting of cardiac arrest. his urine output was low, creatinine was increasing, k+ was increasing and he did not have much response to ns boluses. therefore, cvvh was started and continued for several days. cr and bun were trended, renal function improved and pt was able to be taken off of cvvh. pt autodiuresed successfully. . gu: poor urine output and anatomy restricting use of conventional foley cath. likely hypospadias - require small catheter sized for urethral meatus. gu consult for assistance with foley cath placement. urine output gradually improved after cvvh was started. . s/p fall: pt found down in field, likely diagnosis hypoglycemia and pea arrest. small abrasion on forehead likely to fall trauma. anisocoria blindness - unlikely to be an acute process. ct head clear at osh and repeat ct of head in house was negative for acute intracranial process. ct of c-spine was negative for fracture. . bipolar disorder: home divalproex acid initially was held in setting of hypothermia protocol. however, per neuro consult, it was felt to be safe to restart as pt's clinical condition improved. patient had some sedation when restarting/up-titrating depakote, he was seen by psychiatry to recommending switching to long acting depakote at bedtime. an ammonia level was checked out of concern for depakote side effect and was normal. psychiatry recommended small standing po dose of haldol at night for agitation as well. the patient improved on the new regimen on long acting depakote and haldol and was much more alert during the daytime and his agitation resolved. he will need a valproic acid level on , goal level is 50-80. . anemia and thrombocytopenia: patient may have had mild hitt secondary to heparin as platelets normalized after heparin stopped. anemia etiology unknown, although may have been due to critical illness . neurologic status: the patient will need to follow up with dr. in the anoxic brain injury clinic as an outpatient. he will be discharged to rehab to regain strength and undergo intensive pt and rehab. . pt was full code during this admission. medications on admission: lisinopril 5mg daily metoprolol tartrate 200mg qam, 100mg qpm hctz 25mg daily simvastatin 80mg daily aspirin 81mg daily divalproex er 500mg daily prednisolone ophth eye drops daily? discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 3. divalproex 500 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po qhs (once a day (at bedtime)). 4. haloperidol 5 mg tablet sig: 0.5 tablet po hs (at bedtime): please give at 10 pm check ecg for qtc prolongation. 5. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 6. labetalol 200 mg tablet sig: two (2) tablet po tid (3 times a day). 7. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po daily (daily). 8. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 9. haloperidol 5 mg tablet sig: 0.5-1 tablet po bid (2 times a day) as needed for agitation. 10. acetaminophen 325 mg tablet sig: two (2) tablet po q 8h (every 8 hours) as needed for pain. 11. calcium carbonate 200 mg (500 mg) tablet, chewable sig: tablet, chewables po tid (3 times a day) as needed for indigestion. 12. atorvastatin 40 mg tablet sig: two (2) tablet po once a day. 13. insulin glargine 100 unit/ml solution sig: fifty three (53) units subcutaneous once a day: give before breakfast. 14. insulin aspart 100 unit/ml solution sig: per sliding scale units subcutaneous four times a day: with fs before meals and at hs. 15. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). discharge disposition: extended care facility: - discharge diagnosis: pea cardiac arrest hypoglycemic episode acute renal failure respiratory failure delerium discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , thank you for allowing cardiac care unit to participate in your care. you were initially transferred here from hospital after you experienced a low blood sugar causing you to have a cardiac arrest. you were found down by emergency medical services without a pulse and with blood sugar of 46. at this time, they needed to shock your heart with a defibrillator to regain your heart beat, put a tube down your throat to help you breathe, and start medications to maintain your blood pressure. you were transferred to for a special treatment called artic sun cooling protocol, in which we cooled your body temperature to help prevent damage to your brain and heart after cardiac arrest. you also required dialysis for your kidneys, as they experienced temporary dysfunction during hospitalization. you experienced difficulty breathing during hospitalization. we performed a procedure called bronchoscopy in which we put a camera down into your lungs, and discovered you had aspirated into your lungs the cap to your insulin vial when you had your cardiac arrest. the cap was removed, and your breathing improved, and we were able to wean you off mechanical ventilation. we required you to stay a few more days in the icu in order to manage your high blood pressure and blood sugars. you were then transferred to the regular medical floor until you were ready to be discharged. the following changes were made to your home medications: - your metoprolol was replaced with labatolol for high blood pressures - lisinopril was increased to 10 mg daily - your insulin was changed to 53 units of glargine and a humalog sliding scale. - aspirin was increased to 325 mg daily - divalproex was changed to a long acting dose at 10pm - oxycontin was decreased to 10 mg daily - amlodipine was added for blood pressure control - haldol was added to decrease your confusion at night - calcium carbonate and pantopriazole were added to treat heartburn type symptoms. - colace was added to prevent constipation - tylenol was added to treat your back and chest pain. - hydrochlorothiazide was discontinued. please be sure to follow-up with your primary care week after discharge. we also recommend follow-up with an endocrinologist for management of your high insulin requirements. please check your blood sugars when you wake up, before lunch, and before bedtime, and keep a journal for your doctor so that s/he can adjust your insulin adequately to prevent future hypoglycemic episodes. followup instructions: () 8:30 register 8:30 eye images 9:00 dr. (endocrinologist) 10:00 (diabetic educator) *if your insurance requires a referral, please make the referral out to dr. * . name: , location: - cognitive neurology unit address: , building , , phone: appointment: monday 10:30am procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis other bronchoscopy closed [endoscopic] biopsy of bronchus pulmonary artery wedge monitoring hypothermia (central) (local) endoscopic excision or destruction of lesion or tissue of bronchus removal of intraluminal foreign body from trachea and bronchus without incision diagnoses: acute kidney failure with lesion of tubular necrosis unspecified viral hepatitis c without hepatic coma diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes pulmonary collapse acute respiratory failure cardiac arrest anoxic brain damage hypospadias other shock without mention of trauma diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin obesity, unspecified bipolar disorder, unspecified diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy oliguria and anuria heparin-induced thrombocytopenia (hit) foreign body in main bronchus inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation 

Answer: The patient is high likely exposed to