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: cc: mental status change, hypercarbic respiratory failure major surgical or invasive procedure: bipap history of present illness: mr. is a 68m h/o copd, osa and diabetic nephropathy found on floor at home covered in urine and vomit. unknown how long down. according to daughter has been not taking any of his medications recently (patient denies), and had turned up his home o2 from his baseline 4l nc on because he felt weak. he has also been smoking (1 ppd) and using etoh (reports 3 beers per day; family found empty six-pack of beer in apartment). reports rhinorrhea but no sore throat, cough, myalgias, fevers, chills, or sweats. reports he was eating and drinking regularly. no nausea or vomiting. denies ankle edema, pnd, or orthopnea. . in the ed, was afebrile and hemodynamically stable with bp 134/60, hr 80. he was minimally oriented but denying any complaints. blood gas showed severe acute respiratory acidosis (7.10/112/146), and he was started on bipap. he was also given solumedrol 125mg iv and albuterol/atrivent nebs. subsequent abgs: 7.14/96/63, then 7.20/76/66. also found to be in arf with bun/cr 68/4.2 (baseline cr 2.0 in ) with hyperkalemia at k 6.2. he was started on fluids, given calcium gluconate, insulin with glucose, and kayexylate. f/u k 6 hours later was 6.5, and these interventions were repeated. head ct was unremarkable, and cxr confirmed findings of copd, but no acute cardiopulmonary process. past medical history: 1) chronic obstructive pulmonary disease, no pulmonary function test on record, on 3l nc at home (only with exertion). 2) obstructive sleep apnea on bipap (settings = 12&6 on 8 l oxygen.) 3) type 2 diabetes (last a1c 6.4 on ) c/b biopsy-proven diabetic nephrosclerosis. 4) paroxysmal atrial fibrillation on aspirin 5) chronic renal insufficiency from diabetic nephropathy, baseline cr 2-2.5. followed by dr. . 6) gout 7) anemia 8) hypertension 9) anxiety family history: non-contributory physical exam: afebrile, bp: 190/80 hr: 90 rr: 20 sao2: 88% on bipap gen: wdwn, sleepy, nad, on bipap heent: +proptosis, conjunctival injection bilat, anicteric, op clear, poor dentition neck: supple, no bruits, no thyromegaly or masses cv: rrr, no m/r/g, no jvd chest: poor air movement, + wheezing , incr ap diameter abd: normoactive bs, obese, nontender extr: no le edema, 1+ dps bilaterally neuro: sleepy, cn ii-xii intact, moves all extremities pertinent results: ct head, non-contrast (): this study is severely limited secondary to patient motion artifact. there is no evidence of mass, hydrocephalus, shift of normally midline structures, or infarction. the density values of the brain parenchyma are within normal limits. once again there is prominent exophthalmos which is unchanged significantly compared to . there is bulging of the orbital septum bilaterally and also prominence of the superior rectus muscle. the surrounding osseous, soft tissues and paranasal sinuses are otherwise unremarkable. impression: 1. no evidence of acute intracranial pathology, including no sign of intracranial hemorrhage. 2. again, prominent exophthalmos as described above but unchanged compared to . imaging findings consistent with disease. clinical correlation is recommended. . cxr (): findings: cardiac, mediastinal, and hilar contours are stable in appearance from previous study. the aorta is calcified and tortuous. the pulmonary vasculature is unremarkable. hyperexpanded lungs and flattened diaphragms are again noted, consistent with history of copd. there is no evidence of pleural effusion. allowing for technical limitations and patient motion, as well as a metallic object overlying the extreme lung bases, there is no evidence of pulmonary infiltrate. impression: 1. no evidence of pneumonia. 2. copd. . kub and upright (): abdomen, supine and semiupright. the right lateral abdomen is excluded in the radiograph. air mixed with stool is seen throughout the colon to the level of the rectum. there are no dilated loops of large or small bowel. no free air is seen beneath the hemidiaphragms on the upright view. the lung bases are grossly clear. mild degenerative change is noted in the lower lumbar spine. impression: limited study. no definite obstruction or free intraperitoneal air. brief hospital course: a/p: 69m h/o copd, osa, cri presented with hypercarbic respiratory failure, mental status changes, and acute on chronic renal failure with hyperkalemia in the setting of likely poor med compliance, tobacco and etoh use, and self-increase home o2. . 1) hypercarbic respiratory failure: per old records, baseline abg is 7.30/80/60. initial abg in ed (7.10/112/146) indicates essentially pure acute respiratory acidosis overlying his chronic respiratory acidosis. differential diagnosis for his acute illness includes copd exacerbation missing inhalers (though no wheezing on exam), decreased respiratory drive from turning up home o2, altered mental status uremia from arf. infection was not entirely ruled out, though no clear source, and cxr clear. he was initially managed on the general medicine service, but was later transferred to the medical icu service after he was found to have paridoxical breathing, decreased air movement and agitation. immediately prior to transfer, ativan 0.5 mg iv x 2 was given for an anxiety/withdrawl component of his respiratory distress, and he subsequently became hypoxic to high 80's with a pulse of 90, and bp 190/100. abg on transfer to the micu was 7.12/93/71. in micu, he was bridged through acute exacerbation with constant bipap with treatment for acute copd exacerbation (e.g., nebulizer treatments, antibiotics, and steroids). he remained somnolent for initial micu course possibly secondary to benzodiazepines vs. hypercarbia. on transfer to the floor his respiratory status was stable and he was maintained on bipap at night and o2 nc with goal 02 sat of 88-92%. we continued his prednisone taper. he was discharged to rehabilitation on a 7 day course of levofloxacin for presumed pneumonia. he was continued on his advair and spiriva with prn nebs. . 2) tachycardia: late in the micu course, mr. developed bouts of tachycardia to 140-150 that resolve quickly without intervention. ekg reviewed with cardiology fellow, who believes this represents avnrt vs. atrial flutter. also considered albuterol side-effects; however, bouts of tachycardia persisted long after albuterol held. of note, on , his metoprolol was discontinued due to underlying bronchospastic lung disease, and he was started on diltiazem, so beta-blocker withdrawl was also considered. he was started on diltiazem er and his dose was increased to 360mg qday with good rate control. . 3) acute on chronic renal failure: feurea suggests prerenal etiology, and cr has been improving with hydration now approaching baseline range (baseline 2-2.5). probably dehydration stemming from decreased po intake over last few days (although patient denies). with hyperkalemia to 6.9 in ed, (rec'd ca/gluc/hco3) now down to 4.6. no ecg changes. his creatinine returned to baseline on the floor and at discharge his crt. was 2.7. . 4) altered mental status: resolved with treatment of respiratory failure. etiology of his somnolence was hypercarbia vs. iatrogenic valium he received overnight per ciwa scale implemented on admission. his mental status was much improved on the floors. . 5) etoh: last drink believed to be day pta. briefly used conservative ciwa for some symptoms of withdrawal. now no longer evident. there was evidence of withdrawal during his stay. . 6) dm2: pt. is diet controlled at home. he was started on a riss during his stay as he was given predinisone for his copd flare. he will return to diet control with fingersticks daily after his prednisone course. . 7) hypertension: patient on multiple meds as outpt. attempt to simplify regimen. holding acei arf, but may restart once cr stabilizes. his beta-blocker was stopped due to potential bronchospasms. he was continued on diltiazem er. 8) paf: on aspirin. not anticoagulated, currently in nsr. . full code medications on admission: 1. advair 250-50 mcg inhalation 2. tiotropium bromide 18 mcg capsule 1 cap daily. 3. albuterol-ipratropium 103-18 mcg aerosol 1-2 puffs inhalation q6h. 4. sodium chloride spray sig: sprays nasal qid as needed. 5. atenolol 50 mg daily. 6. lisinopril 20 mg daily. 7. valsartan 80 mg po daily. 8. amlodipine 5 mg daily. 9. furosemide 40 mg daily. 10. aspirin 325 mg daily. 11. docusate sodium 100 mg po bid. 12. senna 8.6 mg po bid. 16. terazosin 2 mg po hs . 17. fluoxetine 20 mg po daily. 18. pantoprazole 40 mg e.c. po q24h. 19. trazodone 50 mg po hs 20. b-complex with vitamin c, 1 tablet po daily. discharge medications: 1. hexavitamin tablet sig: one (1) cap po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. terazosin 1 mg capsule sig: two (2) capsule po hs (at bedtime). 6. diltiazem hcl 180 mg capsule, sustained release sig: two (2) capsule, sustained release po daily (daily). disp:*60 capsule, sustained release(s)* refills:*2* 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 8. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 9. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation every six (6) hours. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 12. prednisone 10 mg tablets, dose pack sig: one (1) tablets, dose pack po once a day for 4 days: 1/19&1/20:2 tabs qday. 1/21&1/22:1 tab qday. disp:*6 tablets, dose pack(s)* refills:*0* 13. levofloxacin 250 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* 14. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 15. outpatient lab work please check cbc, chem 10 on and send results to , ph# 16. regular insulin sliding scale while taking prednisone discharge disposition: extended care facility: - discharge diagnosis: primary: respiratory acidosis altered mental status copd obstructive sleep apnea acute renal failure anemia . secondary: hypertension diabetes mellitus, type ii diabetic nephropathy discharge condition: good discharge instructions: 1. medication issues: -your lasix (furosemide) has been stopped due to your kidney function please discuss with your primary care physician when you should restart this medication. please take all medications exactly as prescribed. medication compliance is very important to preventing future hospitalizations. . call your doctor or return to the ed immediately if you experience worsening chest pain, shortness of breath, nausea, vomiting, sweating, fevers, chills, bleeding, or other concerning symptoms. followup instructions: you are scheduled for the following appointments. please contact the provider with any questions or if you need to reschedule. . provider: , dpm phone: date/time: 2:50 . please call and follow up with your primary care physician weeks. , procedure: non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified acidosis hyperpotassemia nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) tobacco use disorder acute kidney failure, unspecified gout, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation atrial flutter alcohol abuse, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure personal history of noncompliance with medical treatment, presenting hazards to health dehydration diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to