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 / codeine / bactrim attending: chief complaint: nausea/vomiting major surgical or invasive procedure: none history of present illness: ms. is a 65 yo woman with history of chronic diastolic chf, pulmonary hypertension, mixed obstructive and restrictive pulmonary disease, obstructive sleep apnea (uses cpap), type ii diabetes, and chronic kidney disease who presents with 2 days of nausea, hypokalemia, and hypercalcemia. she has had chronic shortness of breath felt to be related to volume overload from chronic diastolic chf. her metolazone was increased to 2x/week about 2 weeks ago. since then she reports decreasing weight (has lost about 7 lbs). one week ago, she began to develop more fatigue and felt that her legs began to buckle more frequently. also endorses worsening leg cramping. she has also felt nausea for the last several days and vomited once two days ago. she was seen by her pcp yesterday who checked electrolytes. she was called by her pcp this morning due to hypokalemia and hypercalcemia and told to come into the ed. in the ed, initial vitals were t 98.2, bp 181/75, hr 59, rr 18, o2sat 97% ra. lab results were significant for stable troponin (0.09), k of 2.7, and calcium of 12.5. in the ed she endorsed shortness of breath and cxr showed evidence of pulmonary edema. she received kcl 60 meq po and 40 meq iv, verapamil sr 240 mg po and carvedilol 12.5 mg po prior to transfer to the medicine floor. currently she reports feeling tired with slight nausea. she reports her breathing feels pretty good. she feels she can walk 150 feet without getting short of breath, but states her functional status has declined significantly after a rehab stay in after an ankle fracture. review of sytems: (+) per hpi. also endorses having chills for 9 months, intermittent fleeting chest achiness that feels "empty" in character, also with constipation (-) denies fever, headache, sinus tenderness, rhinorrhea or congestion. denied diarrhea or abdominal pain. no recent change in bowel or bladder habits. no blood in stool. no dysuria. denied arthralgias or myalgias. past medical history: #. dm type 2 - insulin dependent - c/b retinopathy, neuropathy, and nephropathy - followed by dr. at and her a1c as high as 14 and has come down to to 9.1 #. ckd stage iv: baseline cr 2.1-3.2 #. charcot deformity of the right ankle #. hypertension #. mixed restrictive & obstructive pulm disease (2l oxygen at night) #. pulmonary hypertension (tr grad 32 mmhg tte) #. chronic diastolic chf #. hyperlipidemia #. hypothyroidism #. polymyalgia rheumatica #. fibromyalgia #. s/p tah for fibroids #. depression #. gerd #. osa on cpap (7 with 2l oxygen) - per recent slepe study, many episodes of oxygen desaturation at 70% oxygen saturation. #. cataracts s/p surgery social history: the patient currently lives in , ma by herself. has a home health aide 12 hours daily who drives, cooks, cleans, helps patient bathe and get dressed. she is divorced with 2 children. closest relative is brother who lives in . she is a former secretary. she quit tobacco 12 years ago, with 40+ pack-year history. denies etoh and illicit drug use, states she used to drink alcohol and also quit 12 years ago. per review of omr, has a prior history of abusing vicodin and oxycodone. family history: father with heart problems in his 50s, died from gbm in 60s. mother died of "ascending aneurysm." multiple family members with . physical exam: vs: 142/88 75 18 98%2l general: obese female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. pupils equal with slight stranding of cornea in right eye at site of recent cataract surgery. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. mm appear moist neck: supple with jvp difficult to interpret. cardiac: rr with distant heart sounds. normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: trace peripheral edema in ble. pertinent results: admission labs: 10:30am wbc-11.4* rbc-3.37* hgb-9.7* hct-29.9* mcv-89 mch-28.9 mchc-32.5 rdw-16.8* 10:30am neuts-71.2* lymphs-17.5* monos-8.8 eos-2.1 basos-0.5 10:30am plt count-318 10:30am albumin-3.8 calcium-12.5* phosphate-5.5* magnesium-2.6 10:30am glucose-209* urea n-72* creat-4.4* sodium-137 potassium-2.7* chloride-87* total co2-40* anion gap-13 06:30pm tsh-10* 06:30pm pth-17 studies: ecg: normal sinus rhythm, rate 60. intraventricular conduction delay of left bundle-branch block type. leftward axis. q-t interval prolongation. generalized non-specific repolarization abnormalities. compared to the previous tracing of q-t interval prolongation is new and there are mid-precordial u waves consistent with hypokalemia. cxr: cardiomegaly, mild congestion, trace left pleural effusion. nodular opacities in the right mid lung, possibly representing healing rib fractures, though true pulmonary nodules cannot be excluded. *****a ct of the chest is recommended to further evaluate. findings and recommendations were communicated with housestaff.***** renal ultrasound: 1. right simple renal cysts. 2. normal-appearing left kidney. 3. no evidence of obstructive renal disease. brief hospital course: ms. is a 65 yo woman with history of chronic diastolic chf, pulmonary htn, mixed obstructive and restrictive pulmonary disease, osa on cpap, t2dm, and ckd who presented with nausea, hypokalemia, and hypercalcemia with hospital course complicated by ccu transfer for bradycardia and hypotension. #. hypokalemia: on admission she was hypokalemic to 2.7. this was felt to be related to an increase in her metolazone dosing prior to admission. metolazone was held and her potassium was supplemented and returned to range. she will be discharged on potassium supplements 20 meq po daily at the recommendation of the renal team. patient should have her electrolytes monitored within one week of discharge. #. hypercalcemia: she had hypercalcemia on admission felt to be related to intravascular volume depletion and increase in recent metolazone dosing. she had a normal pth level. her calcium supplements were held, as was her metolazone and she was gently rehydrate and her calcium levels improved. #. acute on chronic diastolic chf: due to her electrolyte abnormalities, she was gently rehydrated with 2 liters of normal saline over 2 days. she gradually became short of breath with this fluid and her oxygenation worsened. her lasix was restarted in intravenous form and her oxygenation improved. she was initially given her home carvedilol and verapamil but then developed bradycardia so these were held. she was changed to a lower dose of verapamil and labetalol. her home lasix was restarted. #. syncope and bradycardia: she developed bradycardia to the 40's on and had an episode of syncope without trauma. she was found to be in complete heart block with junctional escape rhythm felt to be due to accumulation of nodal blocking agents in setting of worsening renal failure. she became hypotensive during this episode and she was transferred to the ccu. she was placed on a dopamine drip transiently for hypotension. her verapamil dose was decreased and her carvedilol was switched to labetalol. her heart rate subsequently remained in normal range. #. ckd stage iv: creatinine elevated on admission to 4.4 from recent baseline of 4.0. her creatinine has trended up slowly over last 3 years. initially her creatinine slightly improved with gentle rehydration but then worsened again with diuresis with iv lasix due to sob and hypoxia. it improved again to her recent baseline. she had a negative renal ultrasound. there was some discussion with the patient that she may been dialysis in the near future and renal team was consulted. patient will need outpatient workup including hep screen and ppd. she underwent venous mapping of her upper extremities during this admission. if patient chooses to continue her predialysis workup at , recommend scheduling an appointment with transplant surgeon dr. (. # osa: continued on home bipap at 18/16 with vented mask #. charcot foot: continued afo brace when oob #. t2dm: she has uncontrolled dm. she is on a complicated insulin regimen with 22 units nph in the morning, 38 units lantus at night plus humalog iss. she was continued on this regimen. blood sugars were well controlled. #. hypertension: she was hypertensive in the ed but improved to normotensive on her home carvedilol, hydralazine, and verapamil. she then became bradycardic and hypotensive and it was felt that these agents may be accumulating due to renal failure. her blood pressures became labile and she was transferred to the ccu. her hydralazine and carvedilol were stopped and replaced with labetalol and prazosin. her verapamil dose was also decreased. she was discharged home on labetolol 100 mg po bid, prazosin 1 mg po bid, and verapamil 40 mg po tid. on this regimen her systolic blood pressure ranged from 120-170. recommend her blood pressures continue to be monitored in the outpatient setting so antihypertensives can be adjusted accordingly. #. anemia: remained at her recent baseline initially but then fell from 29 to 22. she was given 1 unit prbcs without complication and her hematocrit subsequently remained stable. she received a single dose of ferrous gluconate 125 mg iv and was started on daily ferrous sulfate and vitamin c supplements. on day of discharge patient's hematocrit was 27. #. hypothyroidism: continued on levothyroxine 75mcg po daily initially and then this dose was increased to 88 mcg po daily due to high tsh and low t3. #. polymyalgia rheumatica: continued on 7mg prednisone daily #. depression: continued duloxetine. #. cataracts s/p surgery : continued her home eye drops #. code status:: full code, confirmed #. contact: brother medications on admission: carvedilol 12.5mg po bid duloxetine 90mg po daily furosemide 80mg po qam, 40mg po qpm hydralazine 75mg po tid lantus 38 units qhs nph 22 units with breakfast humalog iss 6-24 units with meals per sliding scale levothyroxine 75mcg po daily metolazone 2.5mg po twice per week prednisone 7mg po daily crestor 20mg po daily omeprazole 40mg po daily verapamil sr 240mg po bid caltrate 600 1 tab po daily tramadol er (ryzolt) 200mg po daily docusate mvi 1 tab po daily senna vitamin d3 1000units po daily discharge medications: 1. duloxetine 30 mg capsule, delayed release(e.c.) sig: three (3) capsule, delayed release(e.c.) po daily (daily). 2. furosemide 40 mg tablet sig: two (2) tablet po every morning: and 1 tab (40mg) every evening. 3. lantus 100 unit/ml solution sig: twenty eight (28) units subcutaneous every evening. 4. nph insulin human recomb 100 unit/ml cartridge sig: twenty two (22) units subcutaneous every morning. 5. humalog 100 unit/ml solution sig: insulin sliding scale subcutaneous three times a day. 6. prednisone 1 mg tablet sig: seven (7) tablet po daily (daily). 7. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 9. ryzolt 200 mg tab, multiphasic release 24 hr sig: one (1) tab, multiphasic release 24 hr po once a day. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. labetalol 100 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. verapamil 40 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* 15. levothyroxine 88 mcg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 16. prazosin 1 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 17. moxifloxacin 0.5 % drops sig: ophthalmic qhs (). 18. bacitracin 500 unit/g ointment sig: one (1) ophthalmic qhs (). 19. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic hs (at bedtime). 20. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 21. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 22. outpatient lab work please draw chem 10 and cbc on . please forward results to dr. fax 23. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. disp:*30 tab sust.rel. particle/crystal(s)* refills:*2* discharge disposition: home with service facility: americare at home inc discharge diagnosis: primary diagnosis: hypokalemia hypercalcemia bradycardia with complete heart block anemia secondary diagnosis: type 2 diabetes mellitus chronic kidney disease, stage iv hypertension chronic diastolic chf discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). oxygen saturation at rest is 96% on room air. discharge instructions: you were admitted to the hospital with low potassium levels and high calcium levels in your blood. you were given iv fluids and potassium supplementation and your electrolyte levels improved. it was felt that these levels were due to your recent increase in your dose of metolazone. you also had an episode of slow heart rate and some of your medications were changed to prevent this in the future. your blood counts were low during your admission. you were given 1 unit of blood and started on iron supplementation. . changes to your medications: stopped calcium carbonate and vitamin d stopped metolazone stopped carvedilol stopped hydralazine started labetalol 100mg by mouth twice daily started prazosin 1mg by mouth twice daily started potassium chloride 20 meq (1 pill per day) started ferrous sulfate 325 mg by mouth daily started ascorbic acid 500 mg by mouth daily decreased verapamil to 40mg by mouth three times daily increased levothyroxine to 88mcg by mouth daily followup instructions: it is very important that you have your labs drawn on , . the results should be forwarded to your primary care provider, . . you have the following appointments scheduled in follow-up: name: , s. md when: , , 1:30pm location: diabetes center address: one place, , phone: ** you were also found to have opacities on your chest x-rays that could be nodules in your lung. it was recommended that you get an outpatient ct scan for evaluation. please have your primary care provider order this study ** department: podiatry when: at 11:00 am with: , dpm building: ba ( complex) campus: west best parking: garage name: , s. when: , , 11am address: 1 pl,, , phone: *please call office if you cannot make appointment to reschedule. md, procedure: transfusion of packed cells diagnoses: anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) polymyalgia rheumatica esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified acute on chronic diastolic heart failure other chronic pulmonary heart diseases polyneuropathy in diabetes depressive disorder, not elsewhere classified hypopotassemia other and unspecified hyperlipidemia other specified cardiac dysrhythmias atrioventricular block, complete long-term (current) use of insulin myalgia and myositis, unspecified hypercalcemia background diabetic retinopathy diabetes with neurological manifestations, type ii or unspecified type, uncontrolled arthropathy associated with neurological disorders diabetes with renal manifestations, type ii or unspecified type, uncontrolled saluretics causing adverse effects in therapeutic use diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to