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: no known allergies / adverse drug reactions attending: chief complaint: hyponatremia major surgical or invasive procedure: intensive care addmission eeg monitoring picc line placement lumbar puncture history of present illness: this is a 52 year old lady with unknown pmhx who presents from osh after an unwitnessed fall with hyponatremia. per documented report, her son reports hearing his mother fall on the back porch. he found her unconscious with blood comiung from her mouth. ems found the patient confused and combative which improved on transfer to the osh. the patient reports a 6 day history of flu like symptoms including nausea and emesis. she reports drinking up to 12 bottles of water per day to impove her flu symptoms and then subsequently developing diarrhea. she has not eaten in over six days. the patient reports significant etoh history w/ recent cessation 2 days ago in setting of diarrhea and emesis. she reports drinking approximately 2 drinks per day, last drink about a week ago. never had withdrawal symptoms and states alcohol has never been a problem. she is otherwise a difficult historian. her family reports she drinks 6 glasses of wine per day, does not have a history of w/drawal but has not ever not had wine. they report that she replaced a lot of the wine with water during the last several days. at the osh, initial labs demonstrated a na of 117, k+ of 3.2, cl- 78 and hco3 30 and transaminitis. a cbc demonstrated wbc 5.4, hct 45.2, plts 54. her exam was significant for a posteror lump on her head andevidence of tongue biting. she was confused and not following commands initially. she was given 10meq of potassium for repletion of her potassium. a ct c-spine at the osh revelaed no evidence of gross fracture and a ct head revealed a high density focus noted alont the septum pellucidum concerning for intraventricular hemorrahge given the history of trauma. she was given 1 iv ns with 1meq of kcl. of note, she has been admitted to the osh in the past for hyponatremia and felt to be secondary to beer potomania per records. in the ed, initial vs were: 97.4 108 160/99 22 92%. the patient was noted to be confused and unable to give a history. she was intermittantly combative and exam was significant for upper extremity tremors, nystagmus. an initial cxr demonstrated concern for significant hilar adenopathy concerning for an early infectious process. she spiked a recetal temperature to 100.8. she was started on vancomycin and cefepime for broad spectrum coverage of a possible pneumonia. for her etoh history she was given lorazepam 2mg iv, folic acid 1mg iv x1, and thiamine 100mg iv x 1. review of ct c-spine was normal and her c-spine was cleared. review of her ct head report from the osh was concerning for high density focus intraventricular hemorrhage. a nsg c/s was placed who evaluated the patient in the ed and initially felt the findings were not c/w acute hemorrhage. final recommendations pending on transfer. vitals on tranfer were: 93 21 143/86 96% on 2l nc. on arrival to the micu, initial vitals were: 98.8 101 134/78 92% on 2l nc. she is easily distracted, with slurred speech past medical history: 1. hypnatremia 2. abnormal liver function tests (? etoh induced hepatitis, ast/alt ratio 2:1 in past) 3. thrombocytopenia 4. macrocytosis (mcv 112) 5. hypertension (not treated) social history: - tobacco: 1ppd - alcohol: >6 drinks of wine per day - employment: works at family shop - housing: lives with husband and 2 sons family history: non contributory physical exam: admission exam: vitals: 98.8 101 134/78 92% on 2l nc. general: disoriented, oriented only to self and hosptial, confused and easily distracted heent: sclera anicteric with secretions, mmm, oropharynx clear, eomi, perrl, + horizontal nystagmus, there is also a 1in neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly skin: yellowing of the index fingers gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam: 98.2, 97/59, 66, 18, 100ra general: aox3, at baseline heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl, neck: supple, jvp not elevated, no lad cv: regular rate and rhythm,s1s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 4/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact no asterixis. pertinent results: initial labs: 06:40am blood wbc-5.8 rbc-3.86* hgb-13.6 hct-39.5 mcv-102* mch-35.1* mchc-34.3 rdw-13.7 plt ct-53* 06:40am blood pt-10.5 ptt-26.1 inr(pt)-1.0 06:40am blood glucose-122* urean-3* creat-0.3* na-122* k-2.7* cl-83* hco3-28 angap-14 06:40am blood alt-77* ast-224* alkphos-118* totbili-1.2 12:05pm blood calcium-7.8* phos-2.4* mg-1.4* 08:48am blood osmolal-257* 09:05am blood tsh-2.0 09:05am blood cortsol-32.2* 06:40am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 08:47pm blood o2 sat-88 . pertinent interval labs: 02:22am blood wbc-4.9 rbc-4.10* hgb-14.7 hct-42.8 mcv-105* mch-35.9* mchc-34.3 rdw-13.7 plt ct-103* 02:22am blood pt-10.0 ptt-35.3 inr(pt)-0.9 09:05am blood na-119* k-3.3 cl-84* 12:05pm blood na-125* k-3.3 cl-86* 04:07pm blood glucose-106* urean-3* creat-0.3* na-132* k-3.0* cl-93* hco3-30 angap-12 06:19pm blood glucose-133* urean-2* creat-0.3* na-136 k-2.8* cl-99 hco3-26 angap-14 08:48am blood glucose-116* urean-2* creat-0.3* na-128* k-2.9* cl-90* hco3-28 angap-13 03:51pm blood glucose-109* urean-2* creat-0.2* na-125* k-3.3 cl-88* hco3-28 angap-12 02:22am blood glucose-102* urean-2* creat-0.2* na-131* k-3.6 cl-97 hco3-29 angap-9 07:57am blood glucose-101* urean-3* creat-0.3* na-133 k-4.5 cl-99 hco3-25 angap-14 05:50am blood glucose-98 urean-5* creat-0.3* na-135 k-3.7 cl-99 hco3-27 angap-13 05:18am blood glucose-92 urean-7 creat-0.3* na-136 k-3.3 cl-100 hco3-27 angap-12 02:23am blood alt-61* ast-135* alkphos-97 totbili-0.7 05:29am blood alt-69* ast-136* ld(ldh)-442* alkphos-108* totbili-0.8 02:22am blood alt-68* ast-125* ld(ldh)-389* alkphos-107* totbili-0.8 02:22am blood osmolal-269* 07:57am blood osmolal-272* 03:51pm blood triglyc-72 05:50am blood vitb12-534 folate-12.0 06:40am urine osmolal-219 09:34am urine osmolal-376 05:30pm urine osmolal-297 02:06am urine osmolal-149 06:40am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg . discharge labs: 05:25am blood wbc-4.9 rbc-3.24* hgb-11.6* hct-34.7* mcv-107* mch-35.8* mchc-33.4 rdw-14.1 plt ct-196 05:25am blood glucose-92 urean-5* creat-0.3* na-135 k-3.3 cl-99 hco3-30 angap-9 04:54am blood alt-75* ast-86* ck(cpk)-441* alkphos-87 totbili-0.4 04:54am blood calcium-9.1 phos-3.1 mg-1.5* 05:50am blood vitb12-534 folate-12.0 03:51pm blood triglyc-72 . serologies: 03:51pm blood hbsag-negative hbsab-negative hbcab-negative 03:51pm blood hcv ab-negative . pertinent imaging: -------------------- ct chest : 1. there is no central lymph node enlargement. diffuse bronchial wall thickening is nonspecific and can be seen in aspiration or bronchitis, acute or chronic. 2. fatty infiltration of the liver. 3. right upper lobe nodules and ground glass opacity is likely inflammatory, month followup chest ct is recommended to document resolution. -------------------- ct head : 1. increasing attenuation of the previously-identified intraventricular hyperdense lesion suggests it is most likely an organizing intraventricular hematoma with adherent clot. no new hemorrhage is identified. 2. encephalomalacia in the right frontal lobe consistent with old infarct. 3. subcutaneous sebaceous cyst. -------------------- mri head : 1. a focal lesion in the right lateral ventricle adjacent to the septum pellucidum - likely hematoma; however, consider close followup to confirm based on evolution and exclude underlying lesion. no new areas of hemorrhage are seen. there is no abnormal enhancement seen in the brain parenchyma.a follow-up mri is recommended once hemorrhage resolves to assess for underlying lesion. 2. mild dural thickening and enhancement along the right frontoparietal region- etiology uncertain-correlate with csf analysis (lp not performed) for etiology- infectious/inflammatory. 3. prominent white matter hyperinternse area in the right frontal lobe- consider f/u in a few months to exclude slow growing lesion. 4. enhancing right parietal scalp mass. further evaluation with ultrasound study is recommended to exclude vascular etiology/ mass. -------------------- echo: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef 55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: normal left ventricular cavity size and wall thickness with preserved global and regional biventricular systolic function. no clinically significant valvular regurgitation or stenosis. normal pulmonary artery systolic pressure. ------------------- liver ultrasound: increased liver echogenicity, compatible with fatty deposition. however, more advanced forms of liver disease such as fibrosis or cirrhosis cannot be excluded. no focal hepatic lesion is seen. ------------------- head ultrasound: solid oval subcutaneous scalp mass with internal vascularity. this cannot be further characterized by ultrasonography. the appearance is not consistent with a cyst or hematoma, given the internal vascularity identified on doppler. ------------------- mri c spine: no cord compression; assessment for cord signal changes limited due to motion. ------------------- eeg: abnormality #1: intermittent left mid-temporal theta and delta slowing is seen. background: waking background is characterized by an 8-8.5 hz alpha rhythm which attenuates symmetrically with eye opening. symmetric mcv beta activity is present, maximal over bilateral frontal regions. hyperventilation: could not be performed due to patient's underlying medical condition. intermittent photic stimulation: stepped photic stimulation from flashes per second (fps) produces no activation of the record. sleep: the patient progresses to drowsiness and stage ii sleep with centrally maximal theta and delta activity and symmetric sleep spindles and k complexes appear. cardiac monitor: a single ekg channel shows a generally regular rhythm with an average rate of 75-80 bpm. impression: this is an abnormal routine eeg in the awake and asleep states due to the presence of intermittent left temporal slowing indicative of subcortical dysfunction in this region. no epileptiform discharges are present. brief hospital course: hospital course: this is a 52 year old lady with unknown pmhx who presents from osh after an unwitnessed fall with hyponatremia. . hyponatremia: etiology felt to be multifactorial including hypovolemic hyponatremia in setting of emesis/diarrhea, excess of free water to solute intake exacerbated by recent illness and siadh. her initial sodium was 117 which improved to 122 w/ 2l ns likely improved by her correction of her hypovolemia. with further volume rescussitation in our ed, her subsequent sodium fell to 119 likely to inappropriate adh secretion that became evident when her volume status was corrected. after volume restriction her sodium improved to 125 quickly. further correction of her sodium was made difficult by aggressive k+ repletion in normal saline and lab draws off her picc line. ultimately with 1.5l free water restriction her sodium slowly corrected. she was briefly on d5 to slow correction. a tsh and cortisol were normal. . loss of consicousness: severe hyponatremia and physical exam findings of lacerated tongue concerning for seizure. she was actively withdrawing from etoh on arrival to the floor which could have further reduced her seizure threshold. however, no seizure was witessed and mechanical fall cannot be excluded. per neurology recomendaitons a 20 minute eeg was performed and while some frontotemporal slowing was noted no epileptiform changes were observed. . high density focus: noted along the septum pellucidum concerning for intraventricular hemorrhage on ct head from osh. this was reviewed by neurosugery who felt this finding was tiny and likely represented a cyst. in the setting of persistent altered mental status, a repeat ct head was performed whhich again demonstrated this high denisty focus that appeared more dense and was concerning for a hematoma. neurosurgery evaluated the imaging and recommended mri w/ and w/out contrast which showed a right frontal white matter abnormality of unclear etiology, dural enhancement of unclear significance and a focal lesion in the right lateral ventricle adjacent to the septum pellucidum - likely hematoma. neurology attending did not feel repeat mri prior to discharge would be of value, and neurosurgery did not see role for surgical intervention. patient was discharged with outpatient neurology follow up. lp was performed and cytology pending at the time of discharge. . etoh use: per family history, she was drinking more than 6 glasses of wine per day. serum etoh level prior to transfer negative. last drink ~ days prior to admission. she was tremulous, anxious, disoriented, tachycardic and hypertensive on admission to the icu. she was maintained on a ciwa scale w/ iv lorazepam. her mental status improved by hd 4. she was treated empirically for wernickes with iv thiamine given her profound delirium on admission. social work was consulted and provided counseling though patient felt to be precontemplative. . abnormal liver enzymes: abnormal liver function enzymes in setting of chronic etoh use. ast/alt ratio 2:1 c/w possible etoh hepatitis. a hepatitis panel was negative. liver us showing increased liver echogenicity, compatible with fatty deposition. however, more advanced forms of liver disease such as fibrosis or cirrhosis cannot be excluded. patient discharged with hepatology follow up. . macrocytosis: chronic. likely chronic etoh abuse. she was repleted with iv thiamine and folate. b12 and folate levels were normal. . thrombocytpoenia: chornic. likely chronic etoh abuse. . transitional issues: - patient set up with pcp due to her preferance - right upper lobe nodules and ground glass opacity is likely inflammatory, month followup chest ct is recommended to document resolution - follow-up brain mri given intraventricular hematoma in right lateral ventricle. a follow-up mri is recommended once hemorrhage resolves to assess for underlying lesion. - liver and neurology follow up scheduled prior to discharge - csf cytology pending at the time of discharge. medications on admission: none discharge medications: 1. folic acid 1 mg po daily rx *folic acid 1 mg daily disp #*30 tablet refills:*6 2. multivitamins 1 tab po daily rx *daily multi-vitamin daily disp #*30 tablet refills:*6 3. nicotine patch 14 mg td daily rx *nicotine 21 mg/24 hour (28)-14 mg/24 hour (14)-7 mg/24 hour (14) 1 patch daily disp #*1 kit refills:*0 4. thiamine 100 mg po daily rx *thiamine hcl 100 mg daily disp #*30 tablet refills:*6 discharge disposition: home discharge diagnosis: primary -siadh -hyponatremia -encephalopathy -alcoholic hepatitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were admitted for evaluation of your altered mental status and required an admission to the intensive care unit. your mental status was felt to be secondary to low sodium as a result of a process called siadh. your intake of water was limited to 1.5 l, your sodium corrected an your mental status improved. you also had an mri of your brain which showed some changes of unclear significance. you had a study to measure your brain waves as well which was normal and showed no evidence of seizure. you will need to follow up with our neurologists and may need a repeat mri in about a months time. you were also seen by our liver experts because of your alcohol use at home, an ultrasound showed that you might have developed chirrosis of the liver. you will need to follow up with our liver experts as well. it is extremely important that you quit drinking to prevent a recurrance of your altered mental status and prevent further damage to your liver. given the complex nature of your medical care an appointment with a primary care doctor d for you. the following changes were made to your medications: -start folic acid 1 gm daily -start thiamine 100 mg daily -start multivitamin daily -start nicotine patch 14 mg daily followup instructions: department: when: tuesday at 1:45 pm with: , md building: sc clinical ctr north campus: east best parking: garage dr. is your new physician in and dr. works closely with dr. , both will be involved in your care. for insurance purposes please indicate dr. as your primary care physician. department: liver center when: monday at 9:30 am with: , md building: lm campus: west best parking: garage *please check with your insurance to see if you are required to get a referral for this appointment. we are working on a follow up appointment for your hospitalization in neurology with dr. . it is recommended you follow up within 1 month of discharge. the office will contact you with the appointment information. if you have not heard within a few business days please contact the office at . procedure: venous catheterization, not elsewhere classified spinal tap incision of lung diagnoses: tobacco use disorder unspecified fall other disorders of neurohypophysis delirium due to conditions classified elsewhere other abnormal blood chemistry other and unspecified alcohol dependence, continuous other alteration of consciousness acute alcoholic hepatitis alcohol withdrawal paroxysmal supraventricular tachycardia open wound of tongue and floor of mouth, without mention of complication other specified diseases of blood and blood-forming organs other secondary thrombocytopenia other and unspecified manifestations of thiamine deficiency 

Answer: The patient is high likely exposed to