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: morphine attending: chief complaint: "diabetic ketoacidosis and cp." major surgical or invasive procedure: cardiac catheterization with stent placement in lad history of present illness: mr. is a 61-year-old insulin-dependent diabetic type i, with history of coronary artery disease, transferred from by life flight for dka associated with chest pain. the patient describes a week of intermittent chest pain, associated with progressive lethargy and poor po intake. the patient's wife called the patient on the phone today, and the patient was belligerent and altered. the patient checked his blood sugar and it was 500. the patient was seen at , and found to have a hr 40, bp 70s/30s. ekg showed peaked t waves. the patient was found to have a potassium of 8.0. he was given 2 g of calcium gluconate, 10 units of iv insulin, 50 of bicarbonate, and an aspirin. the patient's ekg changes normalized and the patient became hemodynamically more stable. he was life-flighted to for further management. in the ed, initial vitals were: 94 127/54 12 100% 15l non-rebreather. he denied chest pain, fevers, abdominal pain upon transfer. patient's glucose remained 500. he was given 20 units i.v. insulin, and the rate of his insulin drip was increased to 10/hr. he was given 5 l ivf. the patient's potasium improved to 5. however, his glucose remained critically high. the patient was seen by cardiology, who recommended a stat echo. . in the micu, initial vitals are: 99.3 80 98/53 11 100% 2lnc. the patient states that he continues to be fatigued. he endorses thirst and polyuria. he states that he has also had diarrhea for the past 2 days. over the past day, he has had a non-productive cough. he denies chest pain, fevers, dyspnea, abdominal pain. past medical history: 1)type 1 diabetes a. cardiac risk factors:: diabetes, dyslipidemia, hypertension b. cardiac history: -percutaneous coronary interventions: pci to rca at in 2) cad s/p mi and in 3) sleep apnea 4) hiatal hernia s/p surgical repair, 5) depression 6) gerd 7) retinopathy 8) gastropathy 9) nephropathy (baseline 1.6) 10) pvd s/p status bilateral infrapopliteal revascularization 11) critical pt lesion successfully treated with athrectomy and pta. 12) cognitive/memory issues since mi ) obesity social history: -tobacco history: not a current smoker, quit smoking: in the -etoh: does not drink alcohol -illicit drugs: none -retired courier, married with one son. family history: father: previous mis physical exam: on admission: vs:99.3 80 98/53 11 100% 2lnc gen: alert, oriented x 3 (knows president was on this weekend), slurred speech heent: perrl, eomi, mm dry, cervical lymphadenopathy r>l, no thyromegaly card: normal s1, s2, no murmurs, rubs or gallops resp: clear to auscultation bilaterally abd: obese, mildly distended, soft, non-tender; +bs ext: dry, 1+ dp pulses skin: dry, spider angioma on face neuro: cn ii - xii grossly intact; alert, interactive . on discharge: ******** vs:98.3 56 126/70 18 95%ra gen: pleasant patient lying flat in bed in not acute distress heent: perrl, eomi, mmm, op without erythema or exudate, upper dentures appreicated. no thyromegaly card: rrr. normal s1, s2, no murmurs, rubs or gallops resp: crackles at the basese bilaterally. no wheezes. abd: overweight. mildly distended, soft, non-tender; +bs ext: 1+ dp pulses. 1+ pitting edema bilaterally to the knee skin: dry, pealing skin of the le bilerally. neuro: cn ii - xii grossly intact; alert, interactive and answering questions appropriately. 5/5 strength through all muscle groups of the le bilaterally. pertinent results: on admission: . 03:30pm blood wbc-11.1* rbc-3.28* hgb-10.6* hct-31.4* mcv-96# mch-32.2* mchc-33.6 rdw-12.9 plt ct-248 03:30pm blood neuts-92.6* lymphs-3.9* monos-3.0 eos-0.2 baso-0.3 03:30pm blood pt-12.9 ptt-25.7 inr(pt)-1.1 03:30pm blood urean-68* creat-2.6* 08:49pm blood glucose-807* urean-71* creat-2.9* na-139 k-5.0 cl-103 hco3-23 angap-18 03:30pm blood ctropnt-0.04* 08:49pm blood calcium-8.8 phos-2.1*# mg-2.8* 03:38pm blood glucose-greater th lactate-2.4* na-135 k-5.3 cl-100 calhco3-15* . ce trend: 03:30pm blood ctropnt-0.04* 08:49pm blood ck-mb-9 ctropnt-0.25* 0.35 21:16 0.42 13:00 0.56 06:27 0.61 02:25 0.51 . on discharge: 06:20am blood wbc-9.5 rbc-3.43* hgb-10.8* hct-31.1* mcv-91 mch-31.5 mchc-34.7 rdw-13.2 plt ct-359 06:20am blood glucose-93 urean-50* creat-2.1* na-137 k-4.8 cl-102 hco3-28 angap-12 06:20am blood calcium-8.8 phos-4.9* mg-2.3 . imaging: tte: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior wall. the remaining segments contract normally and global systolic function is preserved (lvef = 60 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction c/w cad. . cxr: impression: ap chest compared to : moderate pulmonary edema has developed in both lower lungs. moderate cardiomegaly is stable, but mediastinal and hilar vascular engorgement have worsened. pleural effusions are small if any. no pneumothorax. . cardiac cath: 1. severe 2 vessel cad with occluded rca proximally and 80% mid lad hazy lesion. 2. successful ptca and stenting of the mid lad with a 2.5x15mm promus des, postdilated to 2.75mm with excellent results. 3. successful closure of the rcfa with a 6f angioseal. 4. dual anti-platelet treatment with plavix (600mg po one-time, then 150mg daily x1 week, then 75mg daily for a minimum of 1 year) and asa 325 mg daily x 3 months, then 162 mg daily. 5. global cv risk reduction strategies. . micro: urine cultures: no growth final blood cultures: and : no growth final : pending brief hospital course: mr. is a 61-year-old insulin-dependent diabetic type i, with history of coronary artery disease, transferred from for dka associated with chest pain. in summary, his dka and hyperkalemia were treated successfully in the micu. upon callout to the floor, he was found to have chest pain and unstable angina with possible nstemi. he was placed on a heparin gtt and then received cardiac cath, during which he received a drug-eluting stent in his mid-lad. his condition improved throughout the rest of admission. . active issues: . #dka - patient transferred from osh with elevated glucose to 500 despite 20 units of iv insulin and 10u/hr iv drip. anion gap on admission 17. patient was bolused with insulin in the icu. his insulin drip was titrated up and his blood sugar values decreased. he was given ns boluses with potassium repletion and converted to 1/2ns for rising sodium level. while in icu, anion gap closed, glucose remained between 150-200 and patient was weaned off drip to s.c. dosing. fingersticks checked q1hr; electrolytes q2hrs and potassium repleted accordingly. etiology of dka likely due to insulin non-adherence in the setting of poor po intake, exacerbated by recent gastroenteritis. cxr with possible new lll opacity, u/a negative. ekg and echo similar to prior, though patient felt to have unstable angina per cardiology team (see below). once the patient was stablized, he was seen by the , who recommended a more stringent insulin regimen given his level of insulin resistance. followed the patient through his hospital course. he is being discharged on a 70units after breakfast and sliding scale insulin with humalog at meals and before bedtime. *insulin regimen should be adjusted, possibly splitting up dose, as does spike to glucoses in the 200-300 range in the afternoons. . #nstemi/cad - per report, patient had short episode of chest pain on admission associated with peaked t waves, and lateral lead st depressions. patient was given aspirin 325mg po. cardiac enzymes cycled, and showed rise in trop to peak of 0.61, with flat ck mb. cardiology was , who initially felt ekg changes and troponin elevation likely due to demand ischemia in the setting of dka. echo with normal systolic function and old area of hypokinesis was consistent with past inferior mi. following transfer from icu to floor, patient had two further episodes of substernal cp, relieved with sl nitro x1. ecg unchanged, and cardiac enzymes continued to trend down. cardiology felt presentation concerning for unstable angina, and recommended initiation of heparin gtt and cardiac cath for further evaluation. he was continued on aspirin, plavix, statin, and beta blocker. lasix and lisinopril initially held in setting of volume depletion and hyperkalemia. patient went for cath on , which showed severe 2 vessel cad with occluded rca proximally and 80% mid lad hazy lesion. a des was placed in the mid-lad and patient was transferred to cardiology post-cath. loaded with plavix (600mg po one-time, then 150mg daily x1 week, then 75mg daily for a minimum of 1 year) and asa 325 mg daily x 3 months, then 162 mg daily. he had no further cp throughout the remainder of admission. he was restarted on acei, and the patient will need to have follow-up labs within 1 week of discharge to monitor potassium and serum creatinine. . #hyperkalemia - patient admitted to osh with k+ of 8.0 with peaked t waves. he was given 50 of bicarbonate and k+ improved to 5. peaked t waves resolved. k+ repleted to keep between 3.3 and 5 while correcting dka. potassium remained stable for the remainder of admission. . #cognitive deficits: he has had episodes of dka in the past, and this episode appears to have been precipitated in part by lack of taking his lantus. his recent neuropsychology testing suggests that he may benefit from rehab or another structured living situation and will require help monitoring his glucose and administering medications. please refer to neuropsychology report from for further details. patient has follow-up with neuropsychology on . . #hypernatremia: in setting of free water loss from dka. he was given d5 1/2ns with insulin drip which was changed to d5w and encouraged free water intake. am of micu d/c to floor he had a 3.5 l free water defecit which was being actively corrected with d5w. this hypernatremia resolved on the floor. on day of discharge, the patient's sodium was 137. . #acute on chronic kidney injury - baseline creatinine from recent records 1.5. elevated to 2.9 on admission. likely prerenal secondary to fluid depletion, and was slowly trending down with fluid administration. patient received pre-cath hydration. patient's serum creatinine 2.1 on day of discharge, stable. he was restarted on acei, and the patient will need to have follow-up labs within 1 week of discharge to monitor potassium and serum creatinine. . #gastroparesis - chronic as side effect of dm. continued on metoclopramide, pantoprazole. . #depression - chronic. continued bupropion, citalopram. held gabapentin on admission out of concern for mental status, though this was later restarted. . transitional issues: . - adhering to his insulin schedule and a diabetic diet should be readdressed with patient and he should be encouraged to have close follow up. insulin regimen may need adjustment to achieve better day time euglycemia. - bcx pending . the following changes were made to the patient's medications: new: - lisinopril: 2.5mg by mouth once a day - aspirin 325 mg by mouth daily x 3 months, then 162 mg daily - atorvastatin 80mg by mouth daily - clotrimazole cream 1 application topically twice per day: apply to right and left inguinal folds for 3 weeks. . changed: - increased: plavix (150mg daily x1 week (last day at this dose ), then 75mg daily for a minimum of 1 year) . stopped: - simvastatin 40mg medications on admission: bupropion hcl - 150 mg tablet extended release 24 hr - 3 tablet(s) by mouth once a day citalopram - 40 mg tablet - 1 tablet(s) by mouth once a day clindamycin phosphate - 1 % swab - apply affected areas pimples twice a day clopidogrel - 75 mg tablet - 1 tablet(s) by mouth once a day furosemide - 20 mg tablet - 1 tablet(s) by mouth every other day (to be titrated up and down by doc) gabapentin - (not taking as prescribed: taking 2 capsules bedtime) - 400 mg capsule - 3 capsule(s) by mouth at bedtime hydrocortisone - 2.5 % cream - apply affected area twice a day 2 weeks on, 2 weeks off insulin aspart - 100 unit/ml solution - inject as per outlined sliding scale per meal as needed for prn insulin - 100 unit/ml solution - 70 units once a day ketoconazole - (not taking as prescribed) - 2 % shampoo - wash scalp and face daily lisinopril - (on hold from to unknown for hypotension) - 2.5 mg tablet - 1 tablet(s) by mouth once a day metoclopramide - 10 mg tablet - 1 tablet(s) by mouth three times a day prn metoprolol succinate - 50 mg tablet extended release 24 hr - 1 tablet(s) by mouth q.d. nitroglycerin - 0.3 mg tablet, sublingual - 1 tablet(s) sublingually prn (as needed) nystatin - (not taking as prescribed) - 100,000 unit/gram powder - apply to groin once daily pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day simvastatin - 40 mg tablet - one-half tablet(s) by mouth daily ( to lower cholesterol) aspirin - (not taking as prescribed) - 325 mg tablet - 1 tablet(s) by mouth daily cholecalciferol (vitamin d3) - (not taking as prescribed) - 1,000 unit capsule - 2 capsule(s) by mouth once daily discharge medications: 1. bupropion hcl 150 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. 2. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 3. gabapentin 400 mg capsule sig: two (2) capsule po hs (at bedtime). 4. gabapentin 400 mg capsule sig: one (1) capsule po once daily at 4 pm. 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 6. metoclopramide 10 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for nausea. 7. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day: hold for sbp<100 mm hg, hr<60. 8. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 11. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day): apply to right and left inguinal folds. . 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily): take 325mg per day for 3 months, then 162mg per day. 13. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily) for 2 days: (last day is ). 14. humalog 100 unit/ml solution sig: sliding scale per sliding scale subcutaneous 4x a day with meals: morning/noon/evening bg units 71-80mg/dl 0 units 81-120mg/dl 12units/10units/10units 121-160mg/dl 14units/12units/12units 161-200mg/dl 16units/14units/ 14units 201-240mg/dl 18units/16units/16units 241-280mg/dl 20units/18units/18units 281-320mg/dl 22units/20units/20units 321-360mg/dl 24units/22units/ 22unit/ 361-400mg/dl 26units/24units/24units >400 md night time bg units 0-70mg/dl 0units 71-80mg/dl 0units 81-120mg/dl 0units 121-160mg/dl 0units 161-200mg/dl 0units 201-240mg/dl 2units 241-280mg/dl 4units 281-320mg/dl 6units 321-360mg-dl 8units 361-400mg/dl 10units >400mg/dl md. 15. outpatient lab work please check full serum chemistry panel (na, k, hco3, bun, cr) in 7 days from discharge, 16. clopidogrel 75 mg tablet sig: one (1) tablet po once a day: once a day for 12 months: take 1 tablet daily after for at least 1 year. . 17. insulin 100 unit/ml solution sig: seventy (70) units subcutaneous qam. 18. furosemide 20 mg tablet sig: one (1) tablet po every other day: hold for sbp<100 mmhg. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: diabetic ketoacidosis unstable angina secondary diagnoses: chronic kidney disease gastroparesis depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a privilege to provide care for you here at the hospital. you were transferred here from for treatment of your diabetic ketoacidosis (very high blood sugar). you were treated with insulin and fluids in the intensive care unit, and after your condition stabilized you were transferred to the regular medical floor. you had several episodes of chest pain, and you were given a cardiac catheterization. a stent was placed in one of your coronary arteries. your condition has stabilized and improved and you can be discharged to your extended care facility. the following changes were made to your medications: new: - lisinopril: 2.5mg by mouth once a day - aspirin 325 mg by mouth daily for 3 months, then 162 mg daily after 3 months - atorvastatin 80mg by mouth daily - clotrimazole cream 1 application topically twice per day: apply to right and left inguinal folds for 3 weeks. . changed: - increased: plavix 150mg daily until thursday , then 75mg daily for a minimum of 1 year . stopped: - simvastatin 40mg . please keep your follow-up appointments as scheduled below. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: you have the following doctor appointments: . department: neurospychology when: thursday at 12:00 pm . department: dermatology when: tuesday at 1 pm with: , md building: (, ma) ground campus: off campus best parking: parking on site . please arrange with your rehabilitation facility follow up with your primary care doctor, dr. , at . procedure: coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: hyperpotassemia subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified constipation, unspecified dysthymic disorder other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled gastroparesis chronic total occlusion of coronary artery 

Answer: The patient is high likely exposed to