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: penicillins attending: chief complaint: hematemesis major surgical or invasive procedure: upper endoscopy with clip placement history of present illness: 72yo m with pmhx of esrd secondary to lithium exposure and interstitial nephritis, diabetes insipidus (lithium toxicity), normal pressure hydrocephalus s/p drain placement (), hypertension, anemia of chronic disease, h/o endocarditis, pulmonary lymphadenopathy and bph who presents with hematemsis. patient was in his normal state of health when he developed 4 episodes of coffee ground emesis on the day of admission. he reports that this occurred after drinking a cup of ginger ale. he denies abdominal pain. he also denies abdomianl pain, melena, hematochezia, or brbpr. the patient denies chest pain, chest tightness, shortness of breath, dizziness. in the ed, the patient was noted to have a hct of 19.8 with hgb 6.0 and mcv 113. inr 1.4 with lactate 3.3. creatinine notable to be 3.8. cxr in the ed notable for moderate left-sided pleural effusion , possible cardiomegaly, and infiltrate in the rll. serum tox screen was negative. ekg w/ nsr at 96 bpm with rbbb and st segement depressions in v1-v3 with twi in v1-v3. gi was consulted in the ed who felt that scope could wait until am. per veral sign out, the patient was mentating appropriately through his ed course despite low sbps. on arrival to the micu, the patient is annoyed; he denies nausea, vomiting, and abdominal pain. past medical history: -esrd lithium exposure and chronic interstitial nephritis on hd (tue//sat) -thrombosis of the lue fistula/graft, catheter associated thrombus in rij -di from lithium toxicity -normal pressure hydrocephalus s/p drain at in -hypertension -anemia of chronic disease -h/o endocarditis -pulmonary lymphadenopathy -bph -cad s/p cabg . past surgical history: -ppm without icd for complete heart block -left avg placement -cabg x 4, resection of tumor from left ventricular outflow tract -left brachiocephalic av fistula placed -left forearm radiocephalic av fistula -left lue graft -left tunneled dialysis catheter placement due to lue graft thrombosis -appendectomy -tonsillectomy . past psychiatric history: - mdd vs bpad type 1 - previous trials of lithium (was helpful but caused kidney toxicity), depakote (was discontinued) - several () hospitalizations in lifetime, no suicide attempts social history: formerly worked at the mfa as a security guard. had lived alone in , now living at center. never married, no children. never smoker. denies alcohol use and illicits. family history: patient denies history of heart disease, diabetes, or cancer. does not know of any other medical problems in his family. history of depression in his father. physical exam: admission: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl 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 gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, lue fistula in place neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge: pertinent results: admission: 08:23pm wbc-6.6 rbc-1.75* hgb-6.0* hct-19.8* mcv-113* mch-34.0* mchc-30.1* rdw-19.4* plt ct-273 08:40pm pt-15.0* ptt-26.6 inr(pt)-1.4* 04:30am glucose-106* urean-68* creat-3.9* na-139 k-5.1 cl-103 hco3-26 angap-15 01:13am alt-12 ast-17 ld(ldh)-177 alkphos-56 totbili-0.2 08:23pm lipase-18 04:30am calcium-9.1 phos-3.2 mg-2.0 01:13am hapto-80 08:23pm -neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 08:36pm glucose-119* lactate-3.3* na-137 k-4.6 cl-100 calhco3-31* 05:54pm lactate-1.5 11:22am igg-663* h. pylori negative discharge: 05:50am wbc-5.5 rbc-3.26* hgb-10.5* hct-33.2* mcv-102* mch-32.2* mchc-31.5 rdw-22.1* plt ct-193 05:50am plt ct-193 05:50am glucose-77 urean-44* creat-5.0* na-132* k-4.7 cl-94* hco3-30 angap-13 05:50am calcium-8.1* phos-3.6 mg-2.2 12:03am lactate-1.9 08:36pm freeca-1.26 reports: egd: erosions in the duodenal bulb old was found in the stomach but no active was seen diffuse esophageal ulcers and severe esophagitis were noted in the lower third of the esophagus. there was also a mix of fresh and thick adherent clot within the moderate sized hiatal hernia. the area was suctioned and irrigated. a few ulcers were noted and two large tears were noted. a total of three clips were applied. two to the larger tear and one to the smaller tear with successful hemostasis. we were unable to remove the adherent clot. no further was noted. medium hiatal hernia esophagitis in the lower third of the esophagus otherwise normal egd to second part of the duodenum cxr: the patient is status post coronary artery bypass graft surgery. a right-sided pacemaker device has been placed, terminating in the right ventricle. there is a moderate pleural effusion on the left with associated opacity, probably due to atelectasis, including volume loss and mild leftward shift of mediastinal structures. aside from streaky and band-like opacities in the right lower lung suggesting minor atelectasis, the right lung appears clear. there is no pleural effusion of the right or pneumothorax. there is no definite evidence for free air. impression: moderate left-sided pleural effusion with substantial suspected atelectasis. no evidence for free air. micro: helicobacter pylori antibody test (final ): negative by eia. brief hospital course: 72yo m with pmhx of esrd secondary to lithium exposure and interstitial nephritis, diabetes insipidus (lithium toxicity), normal pressure hydrocephalus s/p drain placement (), hypertension, anemia of chronic disease, h/o endocarditis, pulmonary lymphadenopathy and bph who presents to the ed with likely upper gi bleed found to have hct 19.8 with mcv 113 for whom gi was consulted admitted for further hd monitoring in light of gi bleed. # gi bleed: patient with gi bleed with evidence of coffee ground emesis prior to ed presentation as well as on lavage in the ed. patient volume resuscitated in the ed with 2l of ns and 1 unit of prbcs was started. upon arrival to the icu, the patient with sbps in the high 100 to 110s, and not tachycardic. the patient currently denies nausea, vomiting, and abdominal pain. ngt with evidence small (approximately 15cc) of in the canister. gi is following the patient. review of endoscopy reports from showing esophagitis, gastritis, and duodenitis. no evidence of varices on last egd. of note, patient previously hospitalized in early with gastro-occult positive emesis. he underwent egd on which showed tear within hiatal hernia and 3 clips were placed. he was transitioned from ppi drip to dosing. h. pylori serology negative. aspiration precautions ordered. he was transfused a total of 5u prbcs and had no additional . ngt was removed when egd done. he should have repeat egd in weeks as an outpatient to ensure resolution. patient with stable hematocrit for several days following last transfusion on and no episodes of additional hematemesis. pressures stable in the 100s-120s on the floor. metoprolol was held given soft bps, and should be titrated back at rehab when his bp tolerates (below). was held by gi following bleed and it was restarted prior to discharge, per their recommendations. # hypotension: patient noted to be hypotensive on morning after admission, trauma line placed. bp improved with prbc and crystalloid infusions. noted to have systolics in the 70s during hd, asymptomatic, improved to baseline of 95-105 systolic once fluid given back. systolic bps stable in 95-100 range prior to floor transfer. on the floor, bps stable in the 100s-130s. metoprolol held initially given soft bps in the icu and was titrated back as bps returned to baseline. # pleural effusion: first noted , tapped by ip, transudative, no growth. he should have continued outpatient work up given loculation on ct. # iv access: patient is a difficult peripheral stick and unable to get iv access to lue in light of fistula. io was placed and then removed and femoral trauma line placed, changed over to cvl for rest of hospitalization given inability to place central line in ij or subclavian given known vasculopathy. his right femoral triple lumen line was removed prior to discharge. # upper extremity edema: patient has chronic upper extremity edema. has been stable throughout admission. this has been extensively worked up in the past. on his last admission, cta without sva syndrome and rue ultrasound did not show thrombus formation. venogram showed uncomplicated right subclavian and central venography. no significant stenosis or venous collaterals. during the current admission, a left upper extremity ultrasound was performed which showed normal flow, compressibility and augmentation. wall-to-wall color flow is seen within the graft throughout. # lactatemia: patient with lactate 3.3 upon presentation, suggesting end organ ischemia in the setting of acute gi bleed. trended down to 1.9 as he was volume resuscitated. # esrd: tuesday, thurdsay, saturday hd schedule. patient did go to hd on saturday prior to admission per hcp report. was continued on his usual hd schedule but was noted to have asymptomatic hypotension with systolics in the 70s at times when trying to remove fluid, improved to baseline 90s with fluid given back. continued nephrocaps, renvela, sensipar. # psyhciatric history: patient with an extensive psychiatric history that includes depression requiring ect as well as episodes of mania. psych meds (valproate, haldol) initially transitioned to iv, back to po once diet advanced along with quetiapine. he had no s/s of mania. # history of cad: patient cp free despite low hct at admission. ekg in the ed is unchanged from prior ekgs. and beta blocker initially held in setting of gib. # history of htn: held metoprolol initially given hypotension secondary to acute bleed. this was restarted while in the hospital at 12.5 mg po bid. this should be should be held on dialysis days as he tends to be hypotensive (asymptomatic during dialysis. # history of bph: held doxazosin in light of acute bleed and should be restarted at rehab as pressure tolerates (as above). # transitional issues: - patient's doxazosin was held given low bps, should be restarted at rehab as bp tolerates - patient continued on home hd schedule (tu th sat) and should resume at rehab - scheduled for gi and pcp follow up - patient should hold metoprolol on dialysis days as he tends to become hypotensive, albeit asymptomatic - he should have continued outpatient work up for pleural effusion given loculation on ct medications on admission: preadmission medications listed are correct and complete. information was obtained from assissted living facility records . 1. doxazosin 8 mg po hs 2. metoprolol tartrate 12.5 mg po bid hold for sbp < 100, hr < 60 3. haloperidol 0.5 mg po bid 4. haloperidol 0.5 mg po prn aggitation 5. quetiapine fumarate 25 mg po qhs 6. aspirin 81 mg po daily 7. acetaminophen 325 mg po q6h:prn fever, pain 8. oxycodone-acetaminophen (5mg-325mg) 1 tab po q6h:prn pain hold for sedation, rr < 12 9. docusate sodium 100 mg po bid 10. divalproex (delayed release) 500 mg po bid 11. nephrocaps 1 cap po daily 12. omeprazole 40 mg po daily 13. sevelamer carbonate 2400 mg po tid w/meals 14. senna 1 tab po bid:prn constipation 15. cinacalcet 30 mg po daily discharge medications: 1. acetaminophen 325 mg po q6h:prn fever, pain 2. cinacalcet 30 mg po daily 3. divalproex (delayed release) 500 mg po bid 4. haloperidol 0.5 mg po bid 5. haloperidol 0.5 mg po prn aggitation 6. nephrocaps 1 cap po daily 7. omeprazole 40 mg po bid 8. oxycodone-acetaminophen (5mg-325mg) 1 tab po q6h:prn pain hold for sedation, rr < 12 9. quetiapine fumarate 25 mg po qhs 10. senna 1 tab po bid:prn constipation 11. sevelamer carbonate 1600 mg po tid w/meals 12. aspirin 81 mg po daily 13. docusate sodium 100 mg po bid 14. metoprolol tartrate 12.5 mg po bid hold for sbp < 100, hr < 60. do not give on dialysis days discharge disposition: extended care facility: healthcare center - discharge diagnosis: primary diagnoses: tear acute loss anemia secondary diagnoses: esrd on hemodialysis cad, hypertension discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital because you were vomiting large amounts of . you spent time in the intensive care unit where you were transfused 5 units of . the gi doctors two vessels in your esophagus and placed clips to stop the . you continued to have your regular dialysis treatments while in the hospital. you were transferred to the general medicine floor and you continued to improve. your counts remained stable and you did not have any additional episodes of bloody vomit. your pressure was low each time you went to dialysis, so you should not take your metoprolol ( pressure medicine) on days that you have dialysis. followup instructions: department: gastroenterology when: friday at 9:00 am with: , md building: lm bldg () campus: west best parking: garage department: advanced vasc. care cnt when: wednesday at 11:00 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: cardiac services when: wednesday at 2:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage md procedure: venous catheterization, not elsewhere classified hemodialysis endoscopic control of gastric or duodenal bleeding central venous catheter placement with guidance diagnoses: anemia of other chronic disease end stage renal disease abdominal pain, unspecified site renal dialysis status unspecified essential hypertension acute posthemorrhagic anemia coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) diaphragmatic hernia without mention of obstruction or gangrene hypotension, unspecified nausea alone esophagitis, unspecified bipolar disorder, unspecified gastroesophageal laceration-hemorrhage syndrome other psychotropic agents causing adverse effects in therapeutic use diabetes insipidus ulcer of esophagus without bleeding edema duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction other specified forms of effusion, except tuberculous idiopathic normal pressure hydrocephalus (inph) chronic glomerulonephritis with other specified pathological lesion in kidney other nonspecific abnormal findings 

Answer: The patient is high likely exposed to