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: sepsis major surgical or invasive procedure: tunneled dialysis line placement paracentesis history of present illness: 51 m hemachromatosis and etohism with cirrhosis, discharged from osh after mssa bacteremia, tense ascites and encephalopathy following a cholescystectomy for gallstones. he was treated with oxacillin for two weeks and d/ced on the . he was readmitted on with weakness, pain and decreased uop, possibly secondary to abdominal compartment syndrome. paracentesis on at hospital removed 6l, bp improved. his creatinine on admit was 4 (from 1) and rose to 10.2 and he was transferred to for cvvh. past medical history: - alcoholic and iron overload cirrhosis complicated by ascites, encephalopathy and variceal bleed. - per patient, two months ago had large volume hemetemesis at the beach, no eval - noted to develop fluid distension 2 weeks ago after chole - encephalopathic in the hospital - cholecytectomy in with complications: - hepatic decompensation - mssa wound infection with bacteremia - malnutrition - history of hypertension - history of depression - s/p thyroidectomy - s/p left rotator cuff repair - s/p removal of left neuroma - s/p left lower extremity nerve release social history: history of heavy alcohol use since he was 13yo, last drink was . he smokes ppd. no drug use. family history: significant for diabetes. physical exam: admission physical exam: vitals:98.5, 100/44, 86, 17, 96%ra general: alert, oriented x3 in nad, resting comfortably at 30deg in bed heent: sclera anicteric, dry mmm, thrush coating tongue and onto hard pallate neck: supple, jvp not elevated, no lad cv: rrr,2/6 systolic murmur at apex radiating to the axilla, no rubs or gallops appreciated lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: protuberant, soft, not tense, normoactive bowel sounds gu: no foley ext: warm, well perfused, 3+pitting edema to the knees bilaterally, trace dp pulses bilaterally, brisk cap refill neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact. no asterixis discharge physical exam: vitals - 99.0 95/43 73 29 99%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, with a holosystolic murmur, lusb, without radiation abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, hepatosplenomegaly, liver edge 3cm below the costal margin. dressings cdi. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: , . no asterixis. pertinent results: admission labs: 10:00pm glucose-82 urea n-61* creat-10.1* sodium-134 potassium-5.9* chloride-100 total co2-18* anion gap-22* 11:08pm type-art temp-37.1 po2-75* pco2-26* ph-7.43 total co2-18* base xs--4 intubated-not intuba 05:20pm alt(sgpt)-25 ast(sgot)-51* alk phos-178* tot bili-0.8 05:20pm albumin-2.7* calcium-8.4 phosphate-6.5* magnesium-2.4 05:20pm wbc-7.4 rbc-3.07* hgb-9.4* hct-29.8* mcv-97 mch-30.6 mchc-31.5 rdw-17.7* 05:20pm neuts-57.3 lymphs-29.4 monos-9.9 eos-2.2 basos-1.2 05:20pm plt count-142* 05:20pm pt-13.1* ptt-38.8* inr(pt)-1.2* discharge labs: 08:02am blood wbc-4.8 rbc-2.81* hgb-8.7* hct-27.1* mcv-97 mch-31.0 mchc-32.0 rdw-18.3* plt ct-115* 08:02am blood plt ct-115* 08:02am blood pt-14.3* inr(pt)-1.3* 08:02am blood glucose-94 urean-28* creat-6.3*# na-135 k-3.7 cl-97 hco3-31 angap-11 08:02am blood totbili-1.5 08:02am blood calcium-8.4 phos-2.5* mg-1.9 05:52am blood caltibc-143* vitb12-* folate-greater th ferritn-36 trf-110* 04:06am blood tsh-1.0 04:06am blood cortsol-22.3* 06:33am blood hbsag-negative hbsab-negative hav ab-negative igm hbc-negative 01:24am blood hiv ab-negative 06:33am blood hcv ab-negative brief hospital course: 51 yo m w/ pmh of cirrhosis to alcohol and hemachromatosis who was undergoing treatment for mssa bacteremia s/p ccy who developed renal failure requiring dialysis who was transferred from an osh for further management. #renal failure - patient was recently treated for mssa bacteremia s/p cholecystectomy with oxacillin. he represented to osh 2 days later found to have weakness, pain and decreased urine output. he was also noted to be hypotensive. his creatinine increased to 10 at which point he was transferred to for further management and cvvh. initially there was concern for possible hrs so he was fluid challenged with albumin and initially treated with octreotide and midodrine. at the osh, his ua was negative. he had an abdominal ultrasound which showed normal sized kidneys without evidence of obstruction. he initially underwent cvvh in the icu, and was eventually able to transition to hd given that he was no longer hypotensive s/p the removal of 4 l of fluid after a paracentesis. per renal, his renal failure was likely due to atn. he was started on dialysis and tolerated this well. given that he is currently dialysis dependent, he did not continue midodrine and octreotide. tunneled line was placed on . ppd negative . hd schedule tu/th/sa. he was started on nephrocaps and calcium acetate # cirrhosis- patient has a cirrhosis due to hemachromatosis and alcohol complicated by hepatic encephalopathy. his meld on icu admission was 22 and remained in the 20s. he was continued on his lactulose and rifaximin, and hepatology was consulted to aid in recommendations for his cirrhosis. egd performed showed 2 stage 1 varices and findings suggestive of barrett's esophagus although no biopsies were taken. hemochromatosis genetic screen sent and showed that he was homozygous for the c282y mutation. his hepatitis serologies were negative. he had 3 theraputic paracentesis during this admission, the last paracentesis was on removing 4.5l. the patient was counseled about the importance of a low salt diet and complete sobriety. he should follow up with hepatology (dr. in 1 month, and have a repeat egd in 1 year. # hypotension- his hypotension was felt in the icu to be most likely secondary to tense ascites. significant improvement of hypotension after therapeutic paracentesis (4l removed) on . given improvement of blood pressure following drop in intra-abdominal pressure, hypotension was most likely secondary to poor venous return due to intra-abdominal hypertension. at osh, he was stated on zosyn for concerns for bacteremia and sepsis, but blood, urine, and peritoneal cultures from there as well as our own were negative, and he had already completed a 2 week course of antibitoics for mssa bacteremia, therefore antibiotics were discontinued. he was briefly on pressors while in the micu, but was able to wean off quickly. tsh and cortisol level were normal. blood pressure remained stable mostly in the 90s. # hypoventilation- overnight on when abdomen tense. sob improved with sitting up in a chair. no fevers, chills or cough. abg showed moderate hypoxemia. likely due to tense ascites causing decreased volume of ventilation. improved with paracentesis. # mssa bacteremia- patient was origianlly treated with oxacillin at the osh with a total 2 weeks of antibiotics. given that patient presented with shock physiology he was initially maintained on broad spectrum antibiotics with vanc and zosyn. cultures from osh and here were negative for bacteremia. at this point hypotension seems most likely secondary to abdominal compartment syndrome. as such, all antibiotics in the micu at were dc'ed, and a tte done in house did not show any vegetations. # anemia- dropped as low as 22.5. no overt signs of bleeding, negative stool guiac. likely multifactorial. hct improved on the floor and remained stable in the high 20s throughout the rest of his course. # etoh abuse- patient given thiamine and folate. the importance of avoiding all alcohol and the risks associated with drinking were discussed with the patient. social work provided him with outpatient resources. # malnutrition- on admission the patient has a low albumin of 1.9, likely both secondary to liver disease and poor nutrition in setting of alcohol abuse. nurtition was consulted and made recommendations to increase calorie intake, with low phos and salt intake and 2l fluid restriction # hypothyroidism- tsh within normal limits. continued home levothryroxine dose. # depression- continued home zoloft. given trazodone 12.5mg po qhs prn insomina # access- patient had picc line and hd line in place on admission. we replaced the picc line while the patient was in the icu. we replaced the hd line with a more permanent tunneled line while on the floor. he underwent mapping for a left arm av fistula. transitional issues - hd schedule tu/th/sa - egd with biopsy in 1 year - vaccinate for hep a and b as outpatient - hcc surveillance every 6 months with afp and abdominal us - no additional labs pending - patient full code during this admission medications on admission: medications at home: lisinopril 40 mg po daily levothyroxine ativan zoloft flagyl 3 times daily oxacillin aldactone folate lactulose thiamin multivitamin rifaximin discharge medications: 1. acetaminophen 650 mg po q6h:prn pain rx *acetaminophen 650 mg 1 tablet(s) by mouth every 8 hours disp #*60 tablet refills:*0 2. folic acid 1 mg po daily rx *folic acid 1 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 3. lactulose 30 ml po tid rx *lactulose 10 gram/15 ml 30 ml by mouth three times a day disp #*3000 milliliter refills:*0 4. levothyroxine sodium 137 mcg po daily rx *levothyroxine 137 mcg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 5. nephrocaps 1 cap po daily rx *b complex-vitamin c-folic acid 1 mg 1 capsule(s) by mouth daily disp #*30 capsule refills:*0 6. pantoprazole 40 mg po q24h rx *pantoprazole 40 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 7. rifaximin 550 mg po bid rx *rifaximin 550 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 8. sertraline 150 mg po daily rx *sertraline 100 mg 1.5 tablet(s) by mouth daily disp #*45 tablet refills:*0 9. thiamine 100 mg po daily rx *thiamine hcl 100 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 10. calcitriol 0.25 mcg po daily rx *calcitriol 0.25 mcg 1 capsule(s) by mouth daily disp #*30 capsule refills:*0 11. calcium acetate 667 mg po tid w/meals rx *calcium acetate 667 mg 2 tablet(s) by mouth tid with meals disp #*180 tablet refills:*0 discharge disposition: home discharge diagnosis: primary diagnoses: cirrhosis renal failure sepsis secondary diagnoses: hypothyroid depression alcohol abuse gastroesophageal reflux disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you while you were admitted to . you were admitted because you had a bacterial infection in your blood and very low blood pressure requiring care in the icu at hospital. while in the icu, your kidneys failed and you needed continuous hemofiltration which required transfer to . your bacterial infection was treated with antibiotics and your blood cultures were negative by discharge. your liver failure, which is due to your alcoholism and hemachromatosis, led to fluid build up in your abdomen and the pressure caused worsening of your low blood pressure and difficulty breathing. this was relieved with repeated paracentesis (draining the fluid with a needle) and fluid being taken off with regular dialysis. you had a endoscopy procedure which showed two stage one varices and mucosal dysplasia which needs to be followed up with another endoscopy with dr. in one year. you also developed a fungal infection which was treated with nystatin and resolved by discharge. you had a tunnelled line placed under anesthesia to protect your access for hemodialysis. you will need to remain on dialysis as an outpatient, your current schedule is tuesday, thursday and saturday. you should stop drinking all alcohol. the social worker has provided you with the following resources: 1) outpatient counseling centers offers addiction counseling on a sliding scale basis. the phone number for is . the closest one to you is located in at . in order to get an appointment, please call the central intake department for outpatient admissions at (this is the extension for admissions). they will carry out an intake on the phone, and then will set up a diagnostic appointment at a counseling center location closest to the patient's house (this will most probably be the one in ). once the patient goes in for an appointment, they will go over a financial agreement which will include a sliding scale fee structure. 2) human services (part of health), in at may offer sliding scale counseling services for addictions. information re: refilling your prescriptions: due to the type of insurance you have (health safety net) you will need to get all your medications filled at the care plus pharmacy here at . the contact information is as follows: ( , each time you need to get your medications filled, you will need to call financial assistance office at to get a clearance form for your medications to be paid for. this call must be made on the same day that you pick up your medication. unfortunately, the pharmacy is not able to mail your medication to you at home. if you need any assistance with this process you can call the medication assistance counselor, at . the following changes have been made to your medication regimen. please start taking - calcium acetate 667 mg by mouth 3 times daily with meals (a new kidney medication to regulate your phosphate levels) - calcitriol 0.25 mg daily (to help regulate your calcium) - nephrocaps 1 tab daily (a vitamin) - pantoprazole 40 mg daily (for your acid reflux) please stop taking - lisinopril - aldactone please take the rest of your medications as prescribed and follow up with your doctors . followup instructions: department: primary care name: dr. when: dr. office is working on a follow up appointment for you in days after your hospital discharge. you will be called by the office with your appoinmtment date and time. location: river medical association address: , , phone: department: liver center when: wednesday at 1:40 pm with: , md building: lm bldg () campus: west best parking: garage procedure: other endoscopy of small intestine hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage diagnoses: hyperpotassemia end stage renal disease tobacco use disorder acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver alcoholic cirrhosis of liver unspecified protein-calorie malnutrition portal hypertension unspecified acquired hypothyroidism candidiasis of other urogenital sites candidiasis of mouth hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other ascites esophageal varices in diseases classified elsewhere, without mention of bleeding other and unspecified alcohol dependence, unspecified hypotension of hemodialysis nontraumatic compartment syndrome of abdomen hereditary hemochromatosis 

Answer: The patient is high likely exposed to