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: s/p fall, ?seizure major surgical or invasive procedure: none history of present illness: mr. is a 47 yo man with schizophrenia who was found down at his group home today and brought to by ems. . most of the history was derived from the pt's group home manager. . the pt was in his usoh until the night prior to admission, when he awoke grunting and clutching his abdomen or penis. he was disoriented at this time. ems was called, his initial blood pressure was allegedly 192/91, and he was taken to hospital, where he was diagnosed with anxiety and discharged back to his group home. . on the day of admission, he was more quiet than usual and had diarrhea all day. at approximately 7 p.m., the pt wandered out of his room and fell on his face without attempting to rbeak his fall. there was evidence of seizure activity, and he later began grunting. according to report, he lost control of his bladder and bowel. . the group home manager noted that the pt drinks about 8 glasses of liquid per day on a chronic basis. he avoids water, however. . in the emergency department, his initial vss were 99.6, 91, 162/102, 22, 94%ra. his initial gcs was 3, and he was intubated for airway protection. there was evidence of posturing and le twitching per report. propofol and lorazepam were administered. a trauma workup demonstrated no evidence of traumatic injury. he received 5 l ns in the ed for hyponatremia. . ros was unobtainable, although the group home manager noted that the pt has lost a significant amount of weight in recent months. past medical history: schizophrenia / mental retardation nephrolithiasis social history: lives at group home located at in . chain smoker per group home staff. family history: unknown physical exam: vitals: t: 100.1 bp: 139/98 p: 98 r: 28 sao2: 98% general: sedated, intubated heent: perrl 4->3.5, mm moist neck: no significant jvd pulmonary: lungs cta bilaterally anteriorly, no wheezes, ronchi or rales cardiac: rr, soft s1 s2, no murmurs, rubs or gallops appreciated abdomen: soft, nt, nd, normoactive bowel sounds, no masses or organomegaly noted extremities: no edema, 2+ radial, dp pulses b/l skin: no rashes or lesions noted. pertinent results: 08:05pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 08:05pm wbc-18.6* rbc-3.64* hgb-13.0* hct-33.2* mcv-91 mch-35.7* mchc-39.1* rdw-12.5 08:05pm neuts-81.0* lymphs-14.3* monos-3.5 eos-1.1 basos-0.1 08:05pm plt count-257 . 08:05pm pt-13.7* ptt-24.6 inr(pt)-1.2* 08:05pm fibrinoge-249 d-dimer-633* . 08:11pm glucose-98 lactate-3.1* na+-120* k+-3.2* cl--83* tco2-24 08:05pm urea n-9 creat-0.7 08:05pm ck(cpk)-5153* amylase-32 08:05pm osmolal-248* 08:05pm tsh-2.7 08:05pm cortisol-29.5* . 09:15pm urine hours-random urea n-102 creat-13 sodium-47 potassium-6 tot prot-<6 09:15pm urine osmolal-163 09:15pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 09:15pm urine color-straw appear-clear sp -1.003 09:15pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:15pm urine rbc-0-2 wbc-<1 bacteria-rare yeast-none epi-0-2 trans epi-0-2 09:15pm urine hemosid-negative eos-negative 11:05pm type-art temp-37.6 tidal vol-600 o2-100 po2-322* pco2-39 ph-7.44 total co2-27 base xs-2 aado2-375 req o2-65 -assist/con intubated-intubated stress test: interpretation: the image quality is adequate but limited due to left arm attenuation. left ventricular cavity size is normal. resting and stress perfusion images reveal uniform tracer uptake throughout the left ventricular myocardium. gated images reveal normal wall motion. the calculated left ventricular ejection fraction is 61% with an edv of 95 ml. impression: 1. normal myocardial perfusion at the level of exercise achieved. 2. normal left ventricular cavity size and systolic function. brief hospital course: ## syncope/? seizure: given hyponatremia, acute course, and history from the field, we determined that mr had likely had a seizure. continuous eeg for >24 hrs was unrevealing as there were no further events in the hospital and there was no focality to the eeg, which revealed slowing consistent with encephalopathy (mr was still sedated during this assessment) but no seizure activity. a ct head was also unrevealing of any mass lesion or clear seizure foci. there was no evidence of trauma other than a superficial facial ecchymosis c/w his fall. he had no arrythmias while with us. porphyria labs, and heavy metal labs were normal. his cks were quite elevated and took several days to trend down; his peak was - these trended down. his mental status returned to baseline over the admission per his family and caretakers. he did not have evidence of polydipsia with us while awake and his group home staff had not observed this; given that he apparently prefers juice and coffee as his drinks and does not like drinking water alone it is unlikely that he would have been able to keep up a significant undetected input to explain hyponatremia. paxil could have caused hyponatremia but he had been on a steady dose for some time and it is not clear why this would have developed now. siadh seemed like a prominent possibility but his hyponatremia resolved here; if this had been a paraneoplastic syndrome we would have expected it to continue, although this should be followed to ensure that there is not a recurrence. the most likely possibility at this point is the most pedestrian in a long differential: he had a diarrheal illness, became dehydrated, got hypovolemic hyponatremia, and because he was on two medicines that lowered seizure threshold and perhaps because of a low inherent seizure threshold (though he has no previous seizure history as far as we were able to determine), he seized in response to this. to support this theory we might have to postulate that mr actually had an underactive thirst mechanism in response to his diarrheal illness, and it may be useful to closely follow his input as the acute episode resolves. apparently as an outpatient mr y drinks coffee which has some diuretic effect and might have slightly accentuated his dehydration relative to his fluid intake. . furthermore, he experienced persistant orthostasis with tachycardia (sinus rhythm) on the medical ; this was only resolved with aggressive iv hydration, which did ultimately succeed in resolving his orthostasis. . psych and neuro services followed and were involved in assessment and plan as described above. additionally psychiatry talked to his outpatient treater who said that mr does tend to decompensate while off of his medicines, so his medications were restarted, and his sodium remained stable throughout the admission. . ## hyponatremia: it was unclear whether this was chronic vs acute and cause of seizure or seizure. we came to believe that it was the precipitating event given that there was no evidence of an underlying seizure disorder, though this certainly would benefit from further outpatient follow-up. the last sodium before this admission which we were able to find was from , which was normal; if he has had sodium levels taken since then it would be useful to compare them to confirm that this was an acute hyponatremia leading to seizure which is our current favored sequence of events. causes of hypovolemic hyponatremia include adrenal insufficiency (there was no clear evidence of this); salt-wasting enteropathy (but his hyponatremia resolved); meds (unlikely as his doses had been stable for some time), and as above, diarrhea (which pt had had all day, according to group home manager). causes of euvolemic hyponatremia include siadh (olanzapine, paroxetine, seizure, no h/o or evidence of pulmonary disease), hypothyroidism (his tsh was within normal limits), psychogenic polydypsia (although as above unlikely to be taking in >8 l/day), low salt diet (not per manager at group home). urine sodium was elevated for degree of hyponatremia, which is c/w renal losses of sodium. urine osms when he came in were c/w siadh, adrenal insufficiency or hypothyroidism, but they corrected; additionally his cortisol and tsh levels ruled out the second and third possibilities and his lack of ongoing hyponatremia suggested against the first. serum osms did not suggest an ingestion. given the totality of the data and the response to aggessive hydration, he most likely had hypovolemic hyponatremia from dehydration. . ## neuropsychiatric disorder(s): he carries a chart diagnosis of schizophrenia but of note he also has reported mental retardation and he is on a mood medication, suggesting that his neuropsychiatric status may be more complex than simple schizophrenia. at any rate we held his paxil and olanzapine for concern for med side effects as precipitants or contributors to the inciting event, though as above psychiatry suggested restarting these, and they were restarted without incident. . ## contact: manager at group home, ; brother . of note, finally, in the evaluation of his tachycardia, a cta was completed which was negative for pe, but that suggested significant coronary calcifications including one seemingly in the mid lad distribution. given this, as stress test was completed, which was normal. . in light of this finding, other medical optimization and evaluation was entertained regarding the possibility of occult cad, including eval for diabetes (a1c normal), bp monitoring (no hypertension), and cholesterol panel (this was not fasting, however, calculated ldl was not in a range requiring treatment). he was started on an aspirin daily. medications on admission: paroxetine 20 mg daily olanzapine 25 mg daily calcium mvi discharge medications: 1. olanzapine 10 mg tablet, rapid dissolve sig: 2.5 tablet, rapid dissolves po daily (daily). disp:*75 tablet, rapid dissolve(s)* refills:*0* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day. disp:*30 patches* refills:*0* discharge disposition: home discharge diagnosis: seizure due to hyponatremia dehydration there is no evidence of diabetes discharge condition: stable discharge instructions: take all medications as prescribed. return to the emergency department for: lightheadedness, seizure, confusion, fever, chest pain followup instructions: , ; call for follow up appointment for within one week of leaving the hospital for repeat evaluation including check of serum sodium level. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube diagnoses: tobacco use disorder hyposmolality and/or hyponatremia other convulsions pneumonitis due to inhalation of food or vomitus dehydration encephalopathy, unspecified rhabdomyolysis mild intellectual disabilities schizophrenic disorders, residual type, chronic 

Answer: The patient is high likely exposed to