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: tape "x10yd / augmentin / hydrocodone / levofloxacin / ciprofloxacin / morphine / fentanyl attending: chief complaint: dyspnea, hypoxia major surgical or invasive procedure: ultrasound-guided renal biopsy cpr (cardiopulmonary resuscitation) history of present illness: ms. is a 35 y/o f with a h/o type i dm, htn, ckd, warm autoimmune hemolytic anemia, depression, and osteoperosis who was recently on the sirs service on when she had a 2 minute cardiac arrest, requiring 5 rounds of cpr, immediately following a renal biopsy prompting a 1-day admission to the micu, who now presents back to the sirs service with hypoxia, continuing bilateral pleural effusions, and concern for mixed respiratory acidemia/metabolic alkalemia of multi-factorial etiology. . the patient was discharged from the sirs service following presentation for anaphylactic response to fluoroquinolones, with subsequent hypoxia due to bilateral pleural effusions of unclear etiology, a normocytic anemia, and nephrotic syndrome on . at that time, the patient was breathing comfortably on room air following aggressive diruesis, with consistent o2sats > 95%. she was discharged on lasix 20 mg po qd, and soon redeveloped shortness of breath, le edema and lethargy prompting her re-presentation to on . a cxr confirmed the presence of recurrent bilateral pleural effusions. she had a desat into the 80s on ra, which resulted in her transfer to the micu. she was aggressively diuresed with iv lasix 40 mg overnight, and was then transferred to the sirs service on after a noticeable improvement in her breathing. . given the presence and recurrent nature of her bilateral pleural effusions, we continued iv lasix 40 mg and consulted the rheumatology and renal teams. both teams agreed that the patient should pursue a renal biopsy, which was performed on , and subsequently she had a cardiac arrest. during the procedure, the patient received versed 100 mg and fentanyl 100 mg, and was conscious and able to follow instructions during the procedure. immediately afterwards though, she became unresponsive during her transit to the recovery room, exhibiting some involuntary jerking activity and was found to not have a pulse. she received 2 minutes of cpr and subsequently regained responsivness. at this point she was placed on telemetry where she a normal sinus rhythm and a palpable pulse. no medication was administered during the event and she was placed on o2 and then transfered to the micu. . in the micu, she was monitored and was stable other than one episode of hypoglycemia with a blood sugar of 14 on the , that was immediately managed with iv d50 and she responded appropriately with improved alertness and appropriate mental status. a cta ruled out pulmonary embolus. she was observed for a few hours and was then transfered to the sirs service. . on the floor, the patient was found in acute respiratory distress, with an initial o2sat in the 40s. the patient was immediately placed on 4l nc and her o2sats increased back to the 90s. she exhibited significant somnolence and altered mental status. an abg taken on 4l gave results of 7.37/62/67/37 and a following one on ra was 7.39/61/47/38. . past medical history: 1. type 1 diabetes complicated by retinopathy and likely nephropathy, diagnosed at age 11. poorly controlled per recent records, with the exception of during her pregnancy when she required tpn (with insulin it) for hyperemesis. she has had multiple episodes of diabetic ketoacidosis. aic was 15.1 appt with her attending dr. . no visits since then. last eye exam - "quiescent" proliferative diabetic retinopathy. 2. depression 3. severe hyperemesis requiring tpn. 4. status post c section at 33 weeks because of hyperemesis. 5. migraines 6. accquired hemophilia (fviii inhibitor in ) treated with steroids and rituximab 7. anti-e and warm autoantibody 8. gerd, antral ulcer 9. hypertension 10. hydronephrosis 11. osteoporosis ( t-score lumbar spine -2.2, femoral neck -3.1) . past surgical history: - cesarean section () - laparoscopic appendectomy () - tab - proximal gastroduodenal artery embolization - excision of a skin mole - achilles avulsion repair social history: the patient does not smoke or drink alcohol, transfusion in . married, living with her husband and one son. a homemaker currently. on disability since . exercises regularly at a gym. family history: has 1 sister, no hx of cancer or bleeding/ blood disorders in family but positive ibd history in grandfather and . physical exam: exam on admission vitals: t: 97.3 bp: 118/62 p: 64 rr: 18 o2: 92% on 2l general: in nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, no lad lungs: crackles bilaterally, with decreased breath sounds at the bases cv: normal rate and regular rhythm, with split s2 best heard at the lusb, no m/r/g abdomen: soft, non-tender, mildly distended, bowel sounds present, no rebound tenderness or guarding, no hepatosplenomegaly gu: deferred ext: 1+ pitting edema, r>l in lower extremities, warm, well perfused, 2+ pulses neuro: aox3, sensory and motor grossly intact exam on discharge: improved lll, decreased bs over rll; small and superficial left dorsal foot ulceration pertinent results: admission labs: 10:00pm blood wbc-6.4 rbc-3.26* hgb-10.1* hct-30.8* mcv-94 mch-31.0 mchc-32.8 rdw-17.0* plt ct-438 10:00pm blood neuts-69.2 lymphs-23.2 monos-4.8 eos-1.7 baso-1.0 10:00pm blood glucose-326* urean-41* creat-1.5* na-136 k-6.0* cl-101 hco3-24 angap-17 06:15am blood glucose-414* urean-39* creat-1.4* na-139 k-4.2 cl-102 hco3-25 angap-16 pertinent trends: cr and k+ 02:41am blood creat-1.3* k-4.2 05:50am blood creat-2.6*# k-4.6 06:45am blood creat-1.5* k-4.8 06:45am blood creat-1.4* k-5.4* 05:15am blood creat-1.4* k-5.6* 02:25pm blood -positive * titer-1:640 dsdna-negative 06:45am blood ama-negative 06:25am blood c3-121 c4-48* 11:50am blood type-art po2-114* pco2-42 ph-7.49* caltco2-33* base xs-8 04:22pm blood type-art po2-47* pco2-61* ph-7.39 caltco2-38* base xs-8 microbiology: blood cultures - negative x2 imaging: cxr (): single ap upright portable chest radiograph: there are interval bilateral basilar opacity, right slightly worse than left, representing combination of bilateral pleural effusions with atelectasis. superimposed infections cannot be excluded. there is no pneumothorax. the cardiomediastinal silhouette, hilar contours, and pulmonary vasculature are normal. there is interval removal of the left-sided picc line. impression: interval moderate bibasilar opacities, likely combination of pleural effusions and atelectasis, but cannot exclude superimposed infection. cxr (): as compared to the prior examination, there is improved aeration at the lung bases with improvement in atelectasis and effusions as well as vascular congestion. no pneumothorax is seen. the cardiomediastinal silhouette is unchanged. . ct chest (): 1. no evidence of pulmonary embolism. 2. persistent moderate bilateral pleural effusions with compressive atelectasis. 3. interval improvement of scattered areas of peri-bronchovascular opacities. 4. two splenic hypodensities, the anterior lesion subcentimeter in size and stable, the second 14-mm lesion along the hilum demonstrates increase in size since . differential includes but not limited to cysts, hamartoma, hemangioma, or lymphangioma. these can be followed by ultrasound. 5. left pectoral subcutaneous emphysema and soft tissue induration likely related to instrumentation. recommend clinical correlation to identify the catheter-like structure terminating in the subcutaneous soft tissue. . abdominal u/s (): 1. nondistended gallbladder with marked wall edema, nonspecific, but may relate to liver dysfunction or hypoproteinemia. no pericholecystic fluid or son sign. no intra- or extra-hepatic biliary dilatation. 2. bilateral pleural effusion. no free fluid is seen. 3. 1.5 cm septated right renal cyst without internal vascularity, with thin septations measure no greater than 1 mm. arterial and venous flow is seen to both kidneys. no hydronephrosis bilaterally. 4. along the anterior cortex of the mid to lower pole of the right kidney, there is an echogenic focus, measuring 1.4 x 0.6 x 1.0 cm, which is avascular, and not definitively within the kidney- most likely perinephric fat. attention at follow-up imaging. brief hospital course: 35 year old female with a pmh for dmi, hypertension, warm antibody, hemolytic anemia, depression, and osteoperosis who presents with a chief complaint of dyspnea. active issues: # code blue/arrest: the patient underwent renal biopsy and received fentanyl/versed for the procedure. when she was being wheeled to recovery she was noted to become ashen and lost a pulse. cpr was performed for 2 minutes following which she had spontaneous return of circulation. bp was in the 160s and hr in the 70s. she was not given epinephrine. cta showed no pe and labs were unrevealing. she did not have abnormalities on ekg. it was thought that she had a vagal episode triggering the unresponsive/pulseless episode. she was monitored overnight in the icu without any problems other than hypoglycemia the next morning in the setting of being npo and receiving nph insulin. this resolved with dextrose. . # dyspnea hypoxemia with hypercarbia: thought to be from pleural effusions, which were seen on cxr. patient was recently admitted with negative work up for the pleural effusions except for a positive and anti ss-a antibody. cardiogenic pulmonary edema was thought to be unlikely given her recent normal echo and cardiac mri. pt did not have any signs of infection. the effusions was ultimately felt to be secondary to her hypoalbuminemia resulting from her nephrotic range proteinuria/diabetic nephropathy. she received antibiotics in the ed and these were stopped upon admission to the icu. she had no fevers, tachycardia, or signs of infection and was diuresed 3l of fluid with improvement of her o2 saturations to the mid 90s on 2l nc o2. she was transferred to the floor and continued to improve on iv lasix 40 mg when she was sent for a renal biopsy per the recommendation of both the renal and rheumatology teams. this is when the patient had a cardiac arrest (as above), was transferred back to the micu, and was returned to the sirs service. on presentation, she had an acute desaturation into the 40s. abgs obtained on 4l and ra revealed a picture of hypercarbia likely from narcotic medication administration and poor inspiratory effort from pleural effusions, chest pain due to cpr and healing rib fractures, in addition to hypoxemia likely from v/q mismatch given elevated a-a gradient and improvement on oxygen. the patient was given iv lasix and kept on 4l of o2 and was slowly weaned off until she was stable on room air with appropriate ambulatory sats, over approximately 3-4 days. . # acute on chronic renal failure: according to notes from prior admission, she had nephrotic range proteinuria and the underlying cause was thought to be due to her diabetes. this was confirmed by renal biopsy which took place on . the patient's creatinine on admission was 1.6, which improved initially following diuresis, but then became elevated to 2.6, 48h after a ct scan, likely due to contrast-induced nephropathy. the patient was not given iv fluids and instead was encouraged to take in po fluids allow for self-regulation. within 3 days, her creatinine downtrended to 1.3 and she was subsequently started on torsemide 40 md qd instead of lasix, and the following day back on her home dose of valsartan 160 mg po qd. after an acute rise in her creatinine to 1.5 in the setting of the valsartan, we chose to discontinue it upon discharge along with a dose adjustment of torsemide to 20mg qd. # hyperkalemia: the patient presented with a k+ of 5.9, which was managed by administration of kayexylate. the etiology of this elevation was unclear. repeat k+ after administration of kayexylate gave a repeat of 4.2 and the patient had a stable k+, with occasional need for repletion with potassium chloride following initiation of diuresis. however, a few days prior to discharge, the patient's k+ was elevated to > 5.0 following initiation of valsartan and thus we administered kayexylate and discontinued the patient's valsartan. her k+ continued to be elevated on discharge but the ekg did not show any acute changes. her electrolytes will be followed closely in days by her pcp. . # diabetes, type 1 poorly controlled: the patient was continued on her home dose of lantus and sliding scale insulin. she was given a diabetic diet. her blood sugars in the hospital were somewhat variable, with a many readings above 400 and a low in the micu of 14, that was managed with 50% dextrose. she was placed on her iss as recommendations and plans to follow-up with them regarding an insulin pump upon discharge. . # hypertension: the patient was continued on her home regimen of amlodipine and metoprolol. her blood pressures were generally well-controlled in the hospital and no changes were made to her regimen, apart from the valsartan as described above. . # anemia: the patient's hct range of 29-30 represents an improvement from discharge range of 24-25. however, the value is still lower than her previous baseline levels and was seen by hematology at her last admission who commented on her hypoproliferative state. given her improved value and her other pressing issues, we did not pursue a work-up in the hospital and we advised she continue to follow-up as planned with the clinic as an out-patient. # rib pain: as a result of chest compressions, the patient noted a very sore chest, with pain managed adequately by tramadol. a limited supply of tramadol was provided to her at discharge. . transitional issues: # follow-up: she has numerous follow-up appointments with her pcp, , hematology, pulmonary, and . her pcp will be following her hyperkalemia closely with outpatient lab draws prior to these appointments. will be discussing the option of an insulin pump as an outpatient. # incidental kidney finding on imaging: per abdominal u/s report - "along the anterior cortex of the mid to lower pole of the right kidney, there is an echogenic focus, measuring 1.4 x 0.6 x 1.0 cm, which is avascular, and not definitively within the kidney - most likely perinephric fat. attention at follow-up imaging." medications on admission: 1) amlodipine 10 mg po/ng daily 2) insulin sc 3) citalopram 40 mg po/ng daily 4) ferrous sulfate 325 mg po/ng daily 5) metoprolol tartrate 37.5 mg po/ng 6) furosemide 40 mg iv once 7) omeprazole 40 mg po daily 8) gabapentin 600 mg po/ng hs 9) senna 1 tab po bid:prn constipation 10) simvastatin 20 mg po/ng daily 11) heparin 5000 unit sc tid 12) ambien 5 mg po qhs prn for insomnia 13) ergocalciferol 50,000u qweekly discharge medications: 1. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 2. torsemide 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 4. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 5. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 6. ferrous sulfate 300 mg (60 mg iron) tablet sig: 1-2 tablets po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 8. gabapentin 600 mg tablet sig: one (1) tablet po at bedtime. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. ambien 5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 11. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a week. 12. lantus 100 unit/ml solution sig: three (3) units subcutaneous qam. 13. lantus 100 unit/ml solution sig: seven (7) units subcutaneous qpm. 14. humalog 100 unit/ml solution sig: iss subcutaneous qidachs. 15. tramadol 50 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain. disp:*24 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: 1. pleural effusions, hypoxia, hypercarbia 2. cardiac arrest 3. acute renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you at the . you were admitted on to the icu with shortness of breath and fluid overload in the lungs. you were given intravenous furosemide (lasix) to help remove the fluid and you appropriately responded to the medication. when you were stable, you were transfered to the floor and were seen by the rheumatology and renal teams, who both recommended a renal biopsy. you received a renal biopsy on , which went well, but immediately following the procedure, you had what was presumed to be a cardiac arrest for 2 minutes. a code was called and you received 5 rounds of cpr. you recovered following the cpr and did not require any medications during the code. once stable, you were transferred to the micu for monitoring and evaluation. when transfered back to the floor on , you had an additional acute oxygen desaturation, but were placed on 4l of oxygen and given intravenous lasix and you recovered well. we closely watched your oxygen levels and you appropriately came off oxygen and had appropriate levels on room air and on the day of discharge. with regards to your kidneys, the biopsy results revealed that your disease is almost entirely related to your diabetes. on , your kidney function acutely declined as indicated by an increase in your creatinine level, likely due to the contrast you received a few days earlier during your ct scan. we conservatively managed this, encouraging you to take in sufficient fluids orally and your creatinine appropriately came down on the day of discharge. once improved, we started you a new diuretic known as torsemide once a day for continual removal of fluid at a dose of 20 mg per day. you also have a mild elevation in your potassium. please avoid high potassium foods until follow up. please have your potassium level checked on follow up. medication changes: 1) continue torsemide 20 mg once a day 2) stop valsartan for now . please seek medical attention for any worsening symptoms. please attend your follow-up appointments below. followup instructions: we have scheduled the following appointments for you: name: , md when: wednesday, :00am campus: east best parking: garage location: **please have your blood drawn on tuesday or wednesday before this appointment. name: , location: diabetes center address: one place, , , phone: appointment: thursday 1:00pm department: west clinic when: monday at 4:00 pm with: , md building: de building ( complex) campus: west best parking: garage department: hematology/oncology when: wednesday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage department: when: monday at 1 pm with: , md specialty: pulmonary, critical care & sleep medicine address: , e/ks-b23, , phone: we are working on a follow up appointment with the pulmonary department within 1-2 weeks. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above. procedure: thoracentesis closed [percutaneous] [needle] biopsy of kidney cardiopulmonary resuscitation, not otherwise specified diagnostic ultrasound of other sites of thorax central venous catheter placement with guidance diagnoses: hyperpotassemia anemia in chronic kidney disease esophageal reflux unspecified pleural effusion adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified ulcer of other part of foot other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) cardiac arrest long-term (current) use of insulin osteoporosis, unspecified hypoxemia swelling, mass, or lump in head and neck other disorders of plasma protein metabolism other specified anemias other specified anemias migraine, unspecified, without mention of intractable migraine without mention of status migrainosus leukocytosis, unspecified diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled cellulitis and abscess of foot, except toes cellulitis and abscess of foot, except toes autoimmune hemolytic anemias gastroparesis bacterial pneumonia, unspecified other diuretics causing adverse effects in therapeutic use proliferative diabetic retinopathy allergic urticaria allergic urticaria nephrotic syndrome in diseases classified elsewhere nephrotic syndrome in diseases classified elsewhere quinoline and hydroxyquinoline derivatives causing adverse effects in therapeutic use other specified forms of effusion, except tuberculous nephrotic syndrome with other specified pathological lesion in kidney other symptoms involving digestive system 

Answer: The patient is high likely exposed to