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: abdominal pain major surgical or invasive procedure: hemodialysis placement and removal of a tunneled hemodialysis catheter colonscopy with polyp removal history of present illness: this is a 63 year old portuguese-speaking man with extensive history of alcoholic cirrhosis, frequent admissions at , now here with right-sided abdominal pain, and increased ascites. starting on wednesday () he began having right-sided abdominal pain. his wife reported that he had increased fatigue, abdominal pain, abdominal girth, and one episode of non-bloody emesis. his wife and cousin denied that he had any episodes of confusion. they explained that he had "pain where they took the water out" on the right. they explained and he affirmed that he has been urinating less. i confirmed the essentials of this history with him during a brief portuguese interpreter phone interview. . in the emergency department his initial vitals were: 97.9, 111/63, 18, 98% on room air. he was found to be guaiaic negative; and he had labs notable for lactate 9.1, wbc 21.3, cr 7.6, glu 15. with low glucose, a d5 drip was started. with consideration of ischemic colitis, the ed sent him for ct scan, ordered without contrast given his renal function; this did not show any signs of ischemia. additionally, he received: 4.5 gm iv zosyn, octreotide 50 mcg iv and octreotide 25 mcg/hr gtt; as well as 1 amp of calcium gluconate. liver and kidney services were consulted in the ed; liver fellow left recs in the ed chart and renal fellow planned for hd in the unit. a diagnostic paracentesis was performed in the ed; the liver service recommended against therapeutic tap for now. past medical history: alcoholic cirrhosis known varices portal vein thrombosis s/p tips dm hypothyroid pituitary mass h/o nephrolithiasis h/o +ppd social history: lives w/ wife at home. independent in adls and ambulation. smokes cigars per day. no alcohol for the last 5 months. ivdu. no etoh since . family history: mother deceased, age 50, cva. father deceased, age 62, stomach problems. one brother living and in good health. two sisters, both living and in good health physical exam: 97.9, 111/63, 18, 98% on room air comfortable, continues to moan periodically, abdominal pain neuro: a0x3, asterixis cv: rrr lung: scattered rales with expiratory wheeze abd: +ve bs, marked distension ,tense abd, no rebound/no guarding ext: trace edema pertinent results: 11:47pm glucose-99 urea n-87* creat-7.5* potassium-6.3* 03:42pm lactate-9.1* 03:10pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:45pm alt(sgpt)-28 ast(sgot)-44* ck(cpk)-40 alk phos-391* tot bili-0.7 02:45pm lipase-94* 02:45pm ctropnt-<0.01 02:45pm ck-mb-notdone 02:45pm ammonia-66* 02:45pm pt-40.6* ptt-39.9* inr(pt)-4.3* 04:09am blood wbc-5.2 rbc-2.79* hgb-8.7* hct-25.3* mcv-91 mch-31.1 mchc-34.3 rdw-16.5* plt ct-99* 04:09am blood neuts-79.0* lymphs-11.9* monos-6.1 eos-2.8 baso-0.2 04:09am blood plt ct-99* 04:09am blood glucose-182* urean-38* creat-4.2* na-138 k-3.8 cl-103 hco3-24 angap-15 04:09am blood phos-2.9 mg-2.2 03:17pm blood lactate-2.4* 04:20am blood freeca-1.03* c.diff negative therapeutic tap y/d: gram stain, cx pending, blood cx x2 pending, urine cx showed yeast (10,000-100,000). brief hospital course: liver cirrhosis, etoh, w/ encephalopathy hepatorenal syndrome worsens prognosis. could have been precipitated by large volume tap on prior admission, though pt has tolerated similar (~5l) in the past. pt has been on transplant list. meld on admission = 41. u/s shows some stenosis from tips in protal circulation.being worked up for liver/renal transplant, f/u workup with transplant surgery team. patient was treated for hrs with improvement. recieved screening colonoscopy which identified one polyp (path pending) on day of discharge. additionally, patient recieved a 3l therapeutic paracentesis prior to discharge. treated with cipro in hospital and continued on prophylactic doses on discharge due to possible history of sbp. patient will need mri head to follow-up on pituitary mass found incidentally on ct. . renal failure, acute (acute renal failure, arf): patient presented w/ arf that was likely hepatorenal syndrome, but perhaps large volume tap on last admission; vs change in hemodynamics infection; vs compartment syndrome from ascites causing pre-renal picture vs metformin side effect. he was admitted to the micu where patient underwent emergent dialysis for significanly elevated lactate and was started on octreotide and midodrine. it was felt that his acute renal failure may have been secondary to hrs related to his recent large volume tap vs lactic acidosis related to metformin versus infection. he had abd u/s which confirmed large amt of ascites with persistent elevated tips velocities. he was initially started on levophed to maintain hemodynamic stability which was discontinued soon after. in addition, he underwent 5l paracentesis which he also tolerated well. given elevated wbc ct and concern for infection pt started empirically on zosyn. peritoneal, blood and urine and stool cultures remain negative to date. he was transfered to the floor. on the floor patient continued to improve only needing dialysis on 2 more occasions, last on . he was continued on octreotide/midodrine/albumin and his cr ranged in the 2.8-3.1 range. due to hypertension and hyperglycemia, octreotide and midrinone were discontinued, but albumin was continued. renal function continued to improve until discharge, with creatinine of 1.8 on discharge. on the day prior to discharge, mr. tunneled hd line was removed without complication. . hypotension possibly due to decreased venous return due to abdominal pressure vs infection/sepsis vs hypovolemia due to fluid sequestration as ascites. briefly needed levophed early in icu course for map <60. his hypotension resolved in the micu. on transfer to the floor patient had no issues with hypotension. . altered mental status (not delirium) per family report, patient admitted with intact mental status, however, appeared confused at times, with mumbling and groaning on. this was thougth to due to hepatic encephalopathy that could have been caused by infection, uti vs sbp, vs acidemia. infectious work up was negative. his acidemia resolved after hd. he was re-started on lactulose and rifaxamin and his ms improved. on the floor patient remained at baseline ms until when he . he was found to be altered aggressive, was given haldol and restrained. his mental status did not improve despite continued treatment with lactulose and rifaxamin. he was transfered to the micu on . in the micu he was treated with albumin, octreotide, midodrine and . also, he was treated empirically with vanc, pip/tazo and then cipro for sbp. he was also given lactulose enemas and had an ngt placed and received ng lactulose titrated to bowel movements. with bm his mental status improved. paracentesis was performed with 4l of turbid fluid taken off with a wbc of 125. ngt d/c'ed with improved mental status. on the floor patient's mental status remained at baseline on current medications and he was discharged at baseline. . coagulopathy: patient with known portal vein thrombosis on chronic coumadin. presented with supratherapeutic inr >3.0. his coumadin was held on admission. once his inr was <2.0 his coumadin was restarted. his inr became therapeutic 2 days after restarting coumadin. coumadin was held on for 3 days due to planned tunneled hd catheter removal and colonoscopy. he was restarted on discharge on 3 mg po qday to follow-up next week for inr check. . lactic acidosis most likely liver failure itself, though metformin toxicity in setting of new renal failure may also be responsible. mesenteric ischemia could be culprit as patient presented with large moderately tense ascites. metformin was discontinued on admission, he underwent a large volume paracentesis 5.5l in the micu and was started on hd. on transfer to the floor the patient's acidosis had resolved and only received hd on 3 occasions. on his ms and became acidemic with a lactate of 6.4. he received a medium volume paracentesis (3.5l) as this appeared to be similar to his presentation. he was transfered to the micu on . he was treated as previously mentioned and his lactate had decreased to 2.8 on . . leukocytosis: no clear source was ever found for the patient's leukocytosis. concern for abdominal source but as above this is not clear after dx tap and ct abd/pelvis. empiric gram negative coverage with vanc/zosyn, which he received for a total 7 days course, his leukocytosis resolved shortly after starting treatment. he had a second episode of acute increase of his wbc, this one on after the episode of ams for which he had to be transfered to the micu. he had been started on cipro on . cipro was continued at treatment doses until his leukocytosis returned to . cipro was continued at sbp prophylactic doses due to quesitonable history of sbp in the past. he was discharged on sbp prohpylaxis to be continued indeffinately. . diabetes patient's oral antihyperglycemics were discontinued as metformin could have been cause for lactic acidosis. on the floor patient was consistently hyperglycemic to 200-400s, despite increasing doses of glargine and iss. was consulted and the recommended changes made on his iss and his bg improved slightly. on the patient was trasfered to the icu for an insulin drip after glucose found to be in the 600s. the drip was d/c'ed after 24 hours with normalization of gap and blood glucose. he was continued on glargine and iss which was continuously changed by while on the floor. blood sugar control was variable during admission, however hba1c was 6.8 when checked. due to possible lactic acidosis from metformin on admission, and in consultation with , mr. was sent home on glargine and hiss after extensive education with his wife and translator. plan was for the patient's wife to check blood sugar and draw up insulin due to his confusion liver disease. appropriate follow-up was coordinated for the patient's management of diabetes. medications on admission: 400 mg tid levothyroxine 100 mcg daily calcium carbonate 500 mg tid cholecalciferol 800 unit daily omeprazole 20 mg daily glipizide 10 mg daily lactulose 30-60 mls po qid metformin 1,000 mg propranolol 40 mg tid warfarin 5 mg qhs discharge medications: 1. 200 mg tablet sig: one (1) tablet po three times a day. 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. calcium carbonate 500 mg capsule sig: one (1) capsule po three times a day. 4. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po once a day. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 6. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po qid (4 times a day). 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 8. insulin glargine 300 unit/3 ml insulin pen sig: thirty six (36) u subcutaneous at bedtime. disp:*1 pen* refills:*2* 9. insulin syringes (disposable) 1 ml syringe sig: one (1) syringe miscellaneous four times a day: for use with sliding scale insulin regimen . disp:*1 box* refills:*2* 10. alcohol swabs pads, medicated sig: one (1) swab topical four times a day: cleanse skin prior to insulin injections. . disp:*1 box* refills:*2* 11. lancets,ultra thin misc sig: one (1) lancet miscellaneous four times a day. disp:*1 box* refills:*2* 12. blood sugar diagnostic strip sig: one (1) test strip in four times a day: for testing with sliding scale regimen. . disp:*1 container* refills:*2* 13. humalog 100 unit/ml solution sig: as dir u subcutaneous four times a day: refer to sliding scale for dose. disp:*1 bottle* refills:*2* 14. glucometer sig: one (1) once. disp:*1 glucometer* refills:*0* 15. coumadin 3 mg tablet sig: one (1) tablet po at bedtime. discharge disposition: home with service facility: homecare discharge diagnosis: primary: alcoholic cirrhosis acute renal failure lactic acidosis hepatic encephalopathy hepatorenal syndrome refractory ascites secondary: portal vein thrombosis diabetes mellitus hypothyroidism pituitary mass discharge condition: hemodynamically stable, afebrile. creatinine 1.8 discharge instructions: you were admitted to the hospital for abdominal pain. you were found to have very abnormal labs and so underwent urgent dialysis. these abnormal labs were likely related to a combination of kidney failure from your liver disease and the metformin you were taking for your diabetes. your course was complicated by fluctuating mental status, high blood sugars, and fluctuating kidney status. you were seen by the endocrinology doctors and started on insulin. you may have had an abdominal infection so you were given antibiotics and should continue on the antibiotic (cipro) to prevent any futher infections. . changes to your medications: stop glipizide stop metformin decrease coumadin to 3 mg by mouth every day start ciprofloxacin 500 mg once daily. start glargine 36u nightly start sliding scale insulin as instructed if eating well. if not eating well, take the dose indicated on the sliding scale. . please check your blood sugar should you feel nauseous, sweaty, confused, or dizzy. if you feel poorly and your blood sugar is less than 100, drink 6oz of juice and call your doctor. if your blood sugar is >400, please call your doctor. . please call the liver clinic or return to the emergency room if you experience fever, chills, nausea, vomiting, abdominal pain, shortness of breath, chest pain, constipation, diarrhea, bloody or black bowel movements, confusion, or any other concerning symptoms. followup instructions: please come to the liver clinic on tuesday, to have your blood work checked. dr will be able to access the results of the pathology on the colon polyp that was removed during your colonoscopy when you see him in the clinic. please follow up with dr practitioner ( burns)on tuesday, at 1:00pm. please discuss your blood sugars and plan for insulin at that visit. echocardiogram phone: date/time: 8:00 , md phone: date/time: 8:00 , transplant social work date/time: 9:00 to complete your work up for liver transplant, you will need to have an mri with contrast of your brain. this is because you were noted to have a small, stable lesion in the base of your brain. ct scans cannot characterize this well so you should have an mri. the mri requires contrast which can be risky to give with your currently abnormal kidney function. procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage arterial catheterization endoscopic polypectomy of large intestine diagnoses: acidosis hyperpotassemia other iatrogenic hypotension tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified essential hypertension alcoholic cirrhosis of liver hepatorenal syndrome unspecified septicemia other and unspecified alcohol dependence, in remission portal hypertension unspecified acquired hypothyroidism sepsis hypopotassemia long-term (current) use of insulin insulins and antidiabetic agents causing adverse effects in therapeutic use iron deficiency anemia, unspecified other ascites anticoagulants causing adverse effects in therapeutic use hepatic encephalopathy hyperosmolality and/or hypernatremia benign neoplasm of colon other and unspecified coagulation defects diabetes with other specified manifestations, type ii or unspecified type, uncontrolled other specified disease of white blood cells portal vein thrombosis esophageal varices without mention of bleeding neoplasm of unspecified nature of endocrine glands and other parts of nervous system 

Answer: The patient is high likely exposed to