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: metabolic encephalopathy. major surgical or invasive procedure: none. history of present illness: is is well known to omed service as he was admitted to our service and transferred on day of admission to . briefly, he is a 54-year-old man with a h/o recurrent gbm, s/p resection, xrt, and chemotherapy. his treatmetn was complicated by pulmonary embolism, seizure, and steroid myopathy resulting in frequent falls who presented to clinic today with increased somnolence and episodes of syncope. he was then directly admitted after ct angiogram was negative for pulmonary embolism and mri of the head was performed. he was accompanied by his wife who provided most of the history. his wife explains that he has had progressive weakness, mainly in his bilateral lower extremities, over the past 2 weeks. he also had become more somnolent over the past several days. patient has had episodes of "passing out," a total of 4 time, the first this past sunday. wife reports that while he was being moved, he had loss of consciousness for minutes. he then awakened without any deficits. there was no evidence of seizure activity. his wife also reports incontinence with his loss of consciousness episodes; one episode was witnessed by emt's and they reported no evidence of seizure activity, just loss of consciousness for several minutes. patient has been involved in a research study to try and decrease his decadron usage secondary to to steroid complications. since his initiation in the trial, his mental status and weakness has become worse. wife reports that he would awaken for a few minutes and then returned to sleep. patient was admitted to omed and placed on high-dose steroids, given ivf's, and diuretics were held. labs revealed severe hypokalemia and hyponatremia and he was transferred to micu for closer monitoring. in , he recieved aggressive potassium repletion and normal saline, picc line was placed, and renal was consulted. his na improved from 120 to 130 and k from 1.7 to 3.8, and he is called out to the floor. currently the patient is feeling well and when asked if he has any complaints, he responds 'just you' - a common response for him per his wife. ros is negative for chest pain, sob, f/c/n/v/d/c. he is eating and drinking now. past medical history: patient was referred to the brain clinic on for a newly diagnosed glioblastoma multiforme. neurologic problems began on when he bumped his head at work. after that, he was dizzy, forgetful, and had blurry vision for a few days. he had a head ct that showed a mass in the left parietal white matter. subtotal resection performed on . radiation was initiated on . medical oncologist is , m.d. in , ma. - s/p a gross total surgical resection by , m.d. at hospital performed on - s/p chemo-irradiation at in , ma from to - s/p 3 cycles of adjuvant monthly temozolomide under the direction of , m.d. in , ma. - tumor returned on surveillance head mri seizure on , started on depakote at 1,500 mg po twice daily pulmonary embolism after 3 cycles of monthly temozolomide, on coumadin, started on lasix for pedal edema - s/p 2 monthly cycles of metronomic temozolomide at 75 mg/m2/day - s/p cyberknife radiosurgery to recurrence in the left occipital lobe cavity - started xerecept protocol on - keppra at 1,500 mg po 3 times daily, pedal edema requiring lasix and zaroxylyn past medical history: ophthalmic zoster (left v1 distribution) severe burns (child) requiring skin grafting to his left leg social history: he works as a painter at at . he has been smoking cigarettes 2.5 pack-per-day for 30 years. he stopped drinking alcohol 9 to 10 years ago. he does not use illicit drugs. family history: his mother had hypertension, and both parents died of myocardial infarction. one brother has hypertension while a sister had breast cancer that was treated. his children are healthy. physical exam: vital signs: temperature is 98.1 f, blood pressure 118/64, heart rate 99, respiratory rate 17, and oxygen saturation 99% in room air. general: morbidly obese, somnolent but awakens to questions. he is awake, alert, and oriented x 1. heent: nc/at. perrla. eomi. mm dry. neck: increased neck girth, difficult to ascertain jvp. no lad. cardiovascular: normal s1, s2 without m/r/g. pulmonary: chest clear to auscultation bilaterally without wheezes or crackles. abdomen: obese, soft, nt/nd with normoactive bs. extremities: he has 1+ le edema and 2+ doralis pedis pulses. neurological examination: his karnofsky performance score is 40. he is sleepy but arousable. he is oriented to person but not date and time. his language is fluent with good comprehension. he has marked psychomotor slowing. his mini-mental status examination showed a score of . cranial nerve examination: his pupils are equal and reactive to light, 4 mm to 2 mm bilaterally. extraocular movements are full. visual field examination is notable for a right hemianopsia. funduscopic examination reveals sharp disks margins bilaterally. his face is symmetric. facial sensation is intact bilaterally. his hearing is intact bilaterally. his tongue is midline. palate goes up in the midline. sternocleidomastoids and upper trapezius are strong. motor examination: he does not have a drift. his muscle strengths are at all muscle groups, except for weakness in the proximal lower extremities at 4-/5. his right deltoid and right handgrip strengths are 4-/5. but his left deltoid and left handgrip strengths are . there is asterixis. his muscle tone is normal. his reflexes are 0 bilaterally. his ankle jerks are absent. his toes are down going. sensory examination is intact to touch and proprioception. coordination examination does not reveal dysmetria. he cannot walk. pertinent results: cta chest no evidence of pulmonary embolism, thoracic aortic dissection, pneumonia. mri head no significant change from with nodular areas of enhancement which presumably represent residual tumor surrounding the postoperative cavity in the left parietooccipital region. there is no significant interval change in the surrounding t2 hyperintensity as above. brief hospital course: this is a 54-year-old right-handed man with a h/o recurrent gbm, s/p resection, xrt, chemotherapy. his treatment is complicated by pulmonary embolism, seizure, and steroid myopathy resulting in frequent falls who presented to clinic on with increased somnulence, weakness, and episodes of syncope. labs on admission showed a sodium of 120 and potassium of 1.7. given these profound lab abnormalities, he was transferred to the icu for closer monitoring, where na and k were repleted and he clinically improved; he was then transferred to the oncology floor for further management. (1) somnolence/encephalopathy: the patient's somnolence and encephalopthy on admission were most likely secondary to his initial metabolic abnormalities as well as his underlying gbm and recently decreased steroids. with correction of metabolic abnormalities, mental status did not improved significantly. he was restarted on decadron with further improvement of his energy level and return to his baseline mental status (awake and oriented x 2). he was also started on ritalin which also decreased his somnulence. (2) hypokalemia: this was likely due to over diuresis. this condition resolved with aggressive repletion. his lasix and zaroxylyn were held and were not restarted at discharge. (3) hyponatremia: etiology was most likely secondary to hypovolemic hyponatremia from poor po intake and diuretic use. his fena was <0.1 but urine osmolality >300 so there was also likely an element of siadh in setting of gbm. this condition resolved with holding of his diuretics and ivf hydration. ivf were stopped once the patient was able to take orals. (4) history of pulmonary embolism: the patient's inr was elevated on admission (likely due to poor po intake causing alteration of gut flora), therefore his coumadin was held until when her was restarted on his prior regimen (5 mg 4x/week and 4 mg 3x/week). his inr will be monitored as an outpatient in the acute rehabilitation facility. (5) recurrent gbm: the patient's primary oncologist is dr . the patient was continued on temozolamide and decadron. further management will be per primary oncologist (6) steroid myopathy: the patient was evaluated and treated by pt and will be discharged to rehabilitation for further therapy. he was maintained on fall precautions. (7) depression: celexa was restarted; ritalin was started. medications on admission: temozolomide 200 mg po daily dexamethasone 2 mg po bid coumadin 5 mg po 4 times per week and 4 mg po 3 times per week lasix 40 mg po a.m. and 20 mg po p.m. compazine 5 mg po daily (before chemotherapy) pepcid 20 mg po q a.m. keppra 1,500 mg po twice daily ativan 0.5 mg po 2 tabs at bedtime bactrim ds 1 tab po 3 times weekly zaroxylyn 2.5 mg po daily celexa 20 mg po daily medications on transfer: dexamethasone 2 mg iv q12 keppra 1500 compazine pantoprazole bactrim colace senna, bisacodyl discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. levetiracetam 500 mg tablet sig: three (3) tablet po bid (2 times a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po qm,w,f (). 6. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 7. dexamethasone 4 mg tablet sig: one (1) tablet po q6h (every 6 hours). 8. warfarin 5 mg tablet sig: one (1) tablet po 4x/week (,mo,we,fr). 9. warfarin 1 mg tablet sig: three (3) tablet po 3x/week (tu,th,sa). 10. methylphenidate 10 mg tablet sig: one (1) tablet po bid (2 times a day). 11. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 12. insulin glargine 8units sc qhs . humalog sliding scale: please administer qid for fingerstick glucose 71-150 mg/dl give 2 units glucose 151-200 mg/dl - 2 units glucose 201-250 mg/dl - 4 units glucose 251-300 mg/dl - 6 units glucose 301-350 mg/dl - 8 units glucose 351-400 mg/dl - 10 units 13. fingersticks please check blood glucose by fingerstick qid discharge disposition: extended care facility: of - discharge diagnosis: primary: hypokalemia and hyponatremia secondary: glioblastoma multiforme steroid myopathy depression discharge condition: stable, tolerating pos, stabilized on medication regimen, and appropriate follow up arranged. discharge instructions: during this visit you have been treated for electrolyte abnormalities. you have been restarted on decadron and celexa and started on a new medication (ritalin). we have discontinued your diuretics. please continue to take all medications as prescribed and to participate in physical therapy as scheduled. please seek immediate medical care if you develop changes in mental status including increasing somnulance, increasing confusion, worsening weakness, or any other concerning symptom. followup instructions: provider: mri phone: date/time: 9:45 provider: , m.d. phone: date/time: 11:00 provider: , m.d. phone: date/time: 11:00 procedure: venous catheterization, not elsewhere classified diagnoses: adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified hyposmolality and/or hyponatremia hypopotassemia malignant neoplasm of parietal lobe toxic myopathy encephalopathy, unspecified volume depletion, unspecified 

Answer: The patient is high likely exposed to