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: acute renal failure, hypernatremia, hyperkalemia major surgical or invasive procedure: egd with biopsy history of present illness: 77m w/hx of cva (left sided weakness), htn and dementia presenting from the nursing care facility with concerns for abnormal labs. patient was found to be hyperkalemic. patient has been not taking in good p.o. he has been spitting his pills and food back out when he is given them. he also had one episode of vomiting earlier today, nonbilious nonbloody. he is afebrile and otherwise well. no increased lethargy noted in nursing facility notes. patient is minimally verbal, and therefore unable to obtain history from patient. in the ed, he was chewing on his iv, refusing treatments, he was noted to be incontinent of urine but refusing foley. per report, he was behaving in such manner at the rehab as well. initial vs were: t 95.6 p 83 bp 127/70 r 16 o2 sat. 98%ra. ekg was notable for peaked lateral t waves, no st elevations/depressions. patient was given calcium gluconate, dextrose, insulin, kayexalate, and 2 l fluid and then admitted. on the floor, patient was calmly resting in bed, without any apparent distress. vitals were hr of 52, bp of 125/83, spo2 of 98% on room air. he was minimally verbal. review of sytems: could not be performed due to patient's inability to speak. past medical history: #stage iii ckd - creatinine 1.4 in #cva (left-sided weakness) #hypertension #hyperlipidemia social history: (per records) the patient came from a facility but had recently been living home with his children. past history of smoking but did not smoke in at least 12 months. no recent alcohol. family history: unable to obtain as pt nonverbal. physical exam: on admission: vitals: t: afebrile, sbp 120s, hr 55, rr 12 99%on2l general: elderly, thin male laying in bed frequently moving. alert, doesn't follow commands or answer questions. heent: sclera anicteric, mmm, oropharynx clear lungs: breathing comfortably, ctab cv: rrr, no mrg abdomen: +bs, soft ntnd ext: warm, 2+ pulses, no clubbing, cyanosis or edema large stage iii malodourous ulcer on right heel with green discharge. neuro: oriented to self, unable to follow commands, partly due to language barrier, cnii-xii intact grossly, but weak on left side. discharge physical exam: physical exam: vitals: 98, 128/64, 67, 18, 97 ra general: comfortable today. sitting and interacting heetn: nc at cv: rrr lungs: ctab abdomen: soft, nttp, no guarding extremities: no swelling, pulses 2+ pertinent results: 02:10pm plt count-449* 02:10pm neuts-81.6* lymphs-14.9* monos-2.4 eos-0.7 basos-0.3 02:10pm wbc-11.6* rbc-5.13 hgb-14.9 hct-48.0 mcv-94 mch-29.1 mchc-31.0 rdw-13.7 02:10pm estgfr-using this 05:40pm urine hyaline-3* 05:40pm urine blood-tr nitrite-neg protein-100 glucose-tr ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-lg 05:40pm urine color-yellow appear-hazy sp -1.017 09:12pm pt-12.3 ptt-25.7 inr(pt)-1.1 09:12pm plt count-370 09:12pm calcium-10.1 phosphate-7.2*# magnesium-3.2* 09:12pm glucose-106* urea n-235* creat-10.4* sodium-176* potassium-5.2* chloride-135* total co2-17* anion gap-29* renal us no evidence of hydronephrosis. atrophic echogenic kidneys, likely reflective of chronic renal disease. ecg probable sinus rhythm with atrial premature beats. left anterior fascicular block. voltage criteria for left ventricular hypertrophy. isolated ventricular premature beats. non-specific st-t wave changes. no significant change compared with previous tracing of . read by: , j. intervals axes rate pr qrs qt/qtc p qrs t 75 198 112 406/ -23 egd: impression: stenosis of the lower esophagus (dilation) small hiatal hernia erythema and few nodules in the stomach antrum (biopsy) erythema and erosions in the duodenum compatible with duodenitis otherwise normal egd to third part of the duodenum egd gastric biopsy stomach, antrum, biopsy: - antral mucosa with chronic active gastritis. - no h pylori discharge labs: 05:05am blood wbc-4.6 rbc-2.96* hgb-8.6* hct-25.6* mcv-87 mch-28.9 mchc-33.4 rdw-15.5 plt ct-324 02:10pm blood neuts-81.6* lymphs-14.9* monos-2.4 eos-0.7 baso-0.3 05:05am blood glucose-91 urean-11 creat-1.5* na-139 k-3.9 cl-108 hco3-24 angap-11 05:05am blood calcium-8.2* phos-2.8 mg-1.6 brief hospital course: patient is a 77 m from nursing care with a pmh of ckd - stage iii, (last cr. 1.4) who was found to be hyperkalemic, hypernatremia and in acute renal failure at nursing facility, had been spitting pills, not drinking, and had an episode of non-bilious,non-bloody vomiting. #. acute renal failure - evidence of creatinine at 1.4 4 months ago. the etiology of the renal failure was likely pre-renal, given reports of poor po intake and highly elevated sodium. patient was seen by the renal consult and hemodialysis was deferred. renal ultrasound did not show any sign of hydronephrosis. the patient was given fluids for several days and his creatinine trended down from 10 to his baseline. he began producing appropriate amounts of urine and we were satisfied that his kidney function was appropriate. #hyperkalemia - evidence of peaked t-waves on ekg. patient was given calcium gluconate and insulin as well as kayexalate on the floor. his hyperkalemia was likely caused by acute renal failure. hyperkalemia resolved with fluid resuscitation and resumption of normal urine output. #hypernatremia - likely related to overall dehydration. his free water fluid deficit was approximately 7 l on admission. he was given 1/2ns with goal of lowering his serum sodium by 10 over 24 hours. his electrolytes were monitored q6h to avoid overcorrecting. he was then changed to d5w for correction. his sodium fell to normal levels and his mental status improved. once he was tolerating food, we stopped fluids and watched his sodium and other electrolytes to see if he could maintain normal electrolytes wtih just po food and hydration. he was successful and we discharged him. #htn: the patient was consistently normo/hypotensive while on our service and his antihypertensives were held. once his blood pressures are consistently above 140, we would like his medications to be slowly restarted given his history of stroke. \ #esbl uti - the patient was found to have esbl uti, and so he was started on meropenem. he received 10 of 14 days of the medications, and should continue the medication for 4 more days. he is also to take flagyl for another 18 days after discharge. # cdiff- the patient developed cdiff while in the icu. the patient will continue flagyl until 2 weeks following the cessation of meropenem. # dementia: patient has known baseline dementia. the patient came in more obtunded than his description, which we attributed to hypernatremia. with the resolution of his hypernatremia, the patient became more alert and interactive. we spoke with the daughter, who agreed that he was closer to his baseline at that point. #.goals of care - per discussion with family members, he was minimally interactive at rehab for quite some time. patient remained dnr/ dni. decision made not to place peg tube. after two family meetings, it was decided that the patient would be rehydrated and he would be sent to a nursing home. patient's daughter was informed given severe dementia and aphasia that the odds of patient developing this issue again are extremely high, even with excellent nursing care, and that given he is at the end of his life each intervention should be carefully considered in the context of the goals we hope to achieve in caring for him. his daughter expressed understanding of this and did have "do not hospitalize" status discussed with her though she has not elected to make this his status as yet. weight on discharge is 127 pounds. # code: dnr/dni (discussed with hcp) transitional issues: -if patient develops systolic blood pressure greater than 140, please restart home antihypertensives. -discharge weight 127 lbs medications on admission: hydrocodone-tylenol 5-500 mg po prn for dressing change folic acid 1 mg po daily vitamin b12 500 mcg po daily vitamin c 500 mg po daily plavix 75 mg po daily mvi daily amlodipine 5 mg po daily ramipril 10 mg po daily aggrenox 200-25 mg po bid baclofen 10 mg po daily namenda 10 mg po daily tylenol 650 mg po daily simvastatin 20 mg po daily ranitidine 150 mg po qhs senna qhs discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. dipyridamole-aspirin 200-25 mg cap, er multiphase 12 hr sig: one (1) cap po bid (2 times a day). 5. baclofen 10 mg tablet sig: one (1) tablet po daily (daily). 6. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours). 10. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours) for 4 days. 11. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 18 days. discharge disposition: extended care facility: nursing and rehab center - discharge diagnosis: 1) esophageal stricture 2) dehydration 3) acute kidney injury 4) dementia discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: mr. , you presented to us dehydrated and malnourished secondary to inability to eat or drink. while with us, we found that your electrolytes were abnormal and that your kidneys had suffered some injury from the dehydration. we first rehydrated you with iv fluids until your electrolytes and kidney function normalized to your normal levels. at that point, we had the gi specialists evaluate your esophagus, and they found that you had a stricture in that area. they opened it with an egd after which you were able to tolerate food and fluids by mouth. we monitored your electrolytes for a few days after the procedure, and determined that you were stable for discharge. here are the changes we made to your medications: stop taking amlodipine stop taking ramipril stop taking hydrocodone . start taking tylenol 1 gram three times a day as needed for pain followup instructions: department: podiatry when: thursday at 9:10 am with: , dpm building: ba ( complex) campus: west best parking: garage procedure: esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: hyperpotassemia urinary tract infection, site not specified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) other late effects of cerebrovascular disease intestinal infection due to clostridium difficile do not resuscitate status encephalopathy, unspecified hyperosmolality and/or hypernatremia stricture and stenosis of esophagus other musculoskeletal symptoms referable to limbs dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to