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: failure to thrive major surgical or invasive procedure: nasogastric tube placement history of present illness: 72 yo french creole-speaking female w/ als, who has had a decline in mental status and abilities to perform adls over the last 1-2 weeks. per daughter she is dysarthric at baseline, however, she has been less responsive and communicative for the past week. not communicating at all. history provided by daughter since patient is now nonverbal and not responding to questions. . for the past couple of weeks prior to admission, patient has become less responsive to their questions and forgetting to eat her meals. usually, meals are delivered during the day and patient is able to feed herself. lately, family has found meals untouched and have resorted to feeding her forcibly. pt has not wanted to get out of the bed and in the past couple of days has occasionally had urinary or bowel incontinence in bed. patient is now requiring assistance walking to get to the bathroom. . in the ed, labs were remarkable for sodium greater than assay (serum sodium >180); serum osms 440. also notable for cr 4.0, up from 0.8. nephrology contact for management of extreme hypernatremia and arf. received 600cc ns before labs came back and then switched to d5 1/2ns at 1pm. . daughter suspects that there is an element of depression to patient's symptoms, not trying or wanting to interact. patient will refuse to do things like open her mouth but then will later be observed to yawn or cough spontaneously. she will open her eyes and regard but not follow commands. has had increased diffuclty eating/swallowing. + weight loss. daughter also noted she has had urinary incontinence which is new. daughter denies noting any recent fevers/chills, cough, nasal congestion or diarrhea. past medical history: als htn arthritis breast ca s/p l mastectomy osa, recently had sleep study which showed nocturnal desats and recommended bipap machine, which has not arrived at home yet social history: home: lives alone but with husband daughter who help in the home daily. she spends most of her days and nights unsupervised at home. she would reportedly feed herself pureed food provided by meals on wheels, toilet, and ambulate without assistance or mobility devices. speech is dysarthric, but she makes attempts to verbalize, write, and shake her head in response to questions. during the day, she is up and around and wanting to go out. usually needs help with bathing and dressing. other: no tob, etoh or illicit substance use. family history: noncontributory physical exam: physical exam on admission: t- 96.1 bp- 167/86 hr- 87 rr- 17 100 o2sat 2l nc gen: cachectic, disheveled elderly woman lying in bed, nad heent: nc/at, dry oral mucosa, poor dentition neck: supple, no carotid or vertebral bruit; neck veins flat cv: rrr, no murmurs lung: cta anteriorly abd: +bs soft ext: no edema skin: + skin tenting on extremities and upper thorax . neurologic examination (excerpted from r3 neuro note, confirmed at bedside): mental status: initially would not open eyes to voice and instead turning her head away. with noxious stim, patient localized, opened her eyes, regarded and raised her first at examiner. does not follow commands and is nonverbal. . cranial nerves: pupils equally round and reactive to light, 4 to 2 mm bilaterally. blinks to threat bilaterally. horizontal eye movements conjugate and intact, some vertical movement with tilting of pt's head. +corneals b/l. bifacial weakness. refuses to open mouth. . motor/sensory: decreased bulk throughout. no obvious fasciculations. will not keep arms elevated but avoids hitting face. when resisting has at least 4/5 strength in biceps and triceps bilaterally. legs are crossed at rest and patient can keep knees bent preventing leg from extending bilaterally but won't keep legs antigravity off bed. . reflexes: +2 and symmetric throughout. toes downgoing bilaterally. . coordination/gait/romberg: pt resists and refuses to stand despite two person assist/attempt. pertinent results: labs chem 7 10:35am blood glucose-118* urean-141* creat-3.9*# na-greater than 180 k-3.5 cl-140* hco3-32 08:15pm blood glucose-253* urean-131* creat-3.3* na-180* k-3.2* cl-139* hco3-28 angap-16 12:14am blood glucose-250* urean-123* creat-3.0* na-178* k-3.2* cl-141* hco3-27 angap-13 07:10am blood glucose-107* urean-13 creat-1.0 na-139 k-3.6 cl-103 hco3-27 angap-13 06:58am blood glucose-83 urean-17 creat-1.0 na-140 k-4.0 cl-102 hco3-28 angap-14 serum osmolality 12:45pm blood osmolal-442* 05:20pm blood osmolal-437* 08:15pm blood osmolal-428* 06:40pm blood osmolal-288 07:35am blood osmolal-287 cbc 10:35am blood wbc-8.8# hct-40.0# plt ct-197 12:45pm blood wbc-8.8 rbc-4.98# hgb-12.9# hct-42.7 mcv-86 mch-25.9* mchc-30.2* rdw-15.8* plt ct-180 04:01am blood wbc-10.4 rbc-4.28 hgb-11.0* hct-37.1 mcv-87 mch-25.7* mchc-29.6* rdw-14.6 plt ct-132* 07:10am blood wbc-6.6 rbc-3.64* hgb-9.9* hct-29.6* mcv-82 mch-27.1 mchc-33.3 rdw-14.7 plt ct-309 06:58am blood wbc-7.3 rbc-3.87* hgb-10.4* hct-31.7* mcv-82 mch-26.7* mchc-32.6 rdw-16.3* plt ct-410 micro bcx, ucx both no growth fe studies 05:46am blood caltibc-208* vitb12-589 folate-13.7 ferritn-124 trf-160* 07:35am blood hapto-271* 05:46am blood iron-22* imaging head ct - no evidence of hemorrhage or recent infarction. mri with diffusion- weighted images is more sensitive for evaluation for acute ischemia/infarct and for vascular detail. cxr - no pneumonia. ecg - sinus rhythm. left atrial abnormality. left ventricular hypertrophy. st-t wave abnormalities, may be due to left ventricular hypertrophy. clinical correlation is suggested. no previous tracing available for comparison. repeat head ct: no acute intracranial pathology including no intracranial hemorrhage. brief hospital course: this is a french-creole speaking 72 year old woman with progressive als who presented with failure to thrive with poor po intake, severe hypernatremia with na greater than 180, and and subacute mental status changes. during hospital course, the patient's hypernatremia was corrected with some improvement in mental status, and the patient had a peg tube place for continued nutrition as patient did not tolerate ng tube feedings and failed two speech and swallow evaluations. plan for her will be to go to rehab facility to continue close monitoring and tube feedings through peg tube. the hospital course is presented by issue below. altered mental status etiology of patient's altered mental status was most likely multifactorial, with a large component secondary to her severe hypernatremia in addition to worsened with depression and als. with correction of her hypernatremia, arf, and with tube feedings for nutrition, the patient has been progressively more interactive through still non-verbal. her mental status slowly improved with the patient being able to understand simple commands and make request using physical gestures. she is a native haitian creole speaker, and with the interpreter, the patient could respond appropriately to questioning using head and hand movements. upon discharge, she was back to a similar mental status compared with the last time she was seen by her outpatient neurologist, dr. . however, it is unclear whether the patient will continue to improve with time. severe hypernatremia the patient presented severe hypernatremia up to 192 estimated at admission which was likely etiology of her decline in mental status. this was likely secondary to poor po and water intake with decreased thirst reflex and ability to swallow. no evidence of other intracranial pathology by negative head ct on admission. she was first admitted to the icu where she was corrected initially with d5w and free water boluses via nasogastric tube. her sodium was slowly corrected from > 180 to 140 over 6 days, with q4hour monitoring of electrolytes and adjustment of fluid boluses and ivf by calculating free water deficit. for the last 11 days in the hospital, the patient's na has been normal 135-144 maintained with free water boluses of 100ml q6h. would recommend to continue to keep close watch on the patient's sodium and adjust free water boluses to keep patient's sodium between 138 to 142. nutrition patient had severly decreased po intake prior to admission and was likely causing her hypernatremia and acute renal failure. she was initially fed with tube feeds via a nasogastric tube. the patient failed her first speech and swallow evaluation, but as her mental status slowly improved throughout her hospital, she was evaluated a second time and failed again. given the patient's difficulty swallowing foods and poor toleration of the ng tube (patient pulling out ng tube numerous times despite restraints), the family agreed to a peg tube placement which was done on . since peg tube placement, the patient has been tolerating tube feeds well. acute renal failure patient was admitted with a creatinine of 3.9, thought most likely pre-renal given her history and her fe na of .31% on admission. her creatinine improved dramatically with iv hydration. upon discharge, her creatinine was 1.0. als: patient was recently diagnosed with als in . she was maintained on her outpatient regimen of rilutek and the glycopyrrolate was increased to 3mg daily to improve sialorrea. anemia the patient had fe studies consistent with fe deficiency anemia with anemia of chronic disease. she was started on po iron during this hospital stay. she had no active bleeding or bruising and received 2 units of prbcs prior to her peg tube placement. on discharge her hct was stable. hypertension patient's diuretics were initially held upon admission given her marked hypovolemia. her blood pressure was stabilized with 12.5mg metoprolol and was stable at 130/74 upon discharge. obstructive sleep apnea patient remained stable on room air during her hospital admission and cpap was not used. code status/goals of care: full code per family in consideration of patient's wishes. the plan of care is to observe patient's mental status, strength, at rehab with continued nutrition through the peg tube. - health care proxy - (c) medications on admission: # rilutek 50mg # glycopyrrolate 2mg (for sialorrhea) # hctz 25mg qd--last dose day pta discharge medications: 1. riluzole 50 mg tablet sig: one (1) tablet po bid (). 2. glycopyrrolate 1 mg tablet sig: three (3) tablet po bid (2 times a day). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 8. insulin regular human 100 unit/ml solution sig: administer subcutaneous as directed by insulin sliding scale injection asdir (as directed). discharge disposition: extended care facility: of discharge diagnosis: primary diagnosis: hypernatremia progressive myotrophic lateral sclerosis secondary diagnosis: difficulty swallowing poor oral intake hypertension anemia of chronic disease arthritis obstructive sleep apnea discharge condition: mental status back to level before this acute illness. serum sodium within normal limits. peg tube in place, tolerating feeds, fluid, medications well. discharge instructions: you were admitted to the hospital with altered mental status, which was most likely secondary to your elevated sodium levels. your sodium levels were dangerously high which we think is likely secondary to your not taking in enough fluids and food prior to your admission. we treated you with intravenous fluids which helped your sodium level improve to safer levels. as this improved, your mental status returned to according to your neurologist, dr. who saw you during your stay here. . regarding your nutrition, you were unable to swallow feeds and we began feeding you with feeding via tube into your stomach. we discussed the possibility of placing a tube directly into your stomach, and you and your family decided that would be best, so you had a peg tube placed into your stomach. . if you have changed or worsened mental status, chest pain, shortness of breath, fevers, chills, or night sweats, please seek immediate medical attention. followup instructions: please follow-up with your social worker , at your previously scheduled appointment on 3:00pm. if you need to reschedule your appointment, please call her office number at . . please also follow-up with your neurologists drs. & on 9:30. if you need to reschedule, please call their office at . . please also follow-up with your primary care doctor, dr. , within the next 1-2 weeks following your discharge from the hospital. the phone number is . procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension acute kidney failure, unspecified unspecified protein-calorie malnutrition personal history of malignant neoplasm of breast depressive disorder, not elsewhere classified iron deficiency anemia, unspecified anticoagulants causing adverse effects in therapeutic use encephalopathy, unspecified hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to