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: no allergies/adrs on file attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: 27 yo female with history of migraine headaches and menometorrhagia presents with altered mental status found to have hyponatremia. in , she started a new position as a senior analyst in investment consulting for a firm in . her job is stressful but per her mother's report she has been doing well. around the same time, the family reports that the patient's cousin hacked into her blackberry and her facebook account. she was suspicious that her friends might be involved in the hacking because she reports they knew information that they should not have known. as a result of her job and the hacking, she became more stressed with increased migraines, insomnia, and fatigue. she went to see her physician in for her fatigue. they prescribed her with iron tabs for iron deficiency anemia given her heavy periods. however, she did not take her iron pills because she has always been skeptical of medications. she had to take time off from work because of her migraines and since she was very paranoid about technology. she tried to report the hacking to the authorities but they turned her down since she did not have enough evidence. she has been increasingly paranoid that people were hacking her phone and social media accounts. in addition, she had to break off an unhealthy relationship at this time. she came home to visit her parents and arrived on . her parents report that she was acting normally for the first week. at baseline, she is "a model child" who is moral and extremely close with her parents, especially her mother. she has been complaining of a headache daily. two days ago, she checked facebook for the first time since the incident. immediately afterward, she was very upset with a worsening headache. she was yelling at her parents for "not understanding and being calm" and then apologize for causing them anxiety. over the past 48 hours, she has reported being dehydrated, and has been drinking profuse amounts of water. at one point, she was pouring a pitcher of water on herself. she reports feeling unwell, not like herself, and with a headache. her headaches are typically unilateral but now her headache is bilateral and frontal. she has had trouble sleeping. of note, she traveled to one year ago. her mother also reports a bug bite a few months ago. today, her headache worsened and she had projectile vomiting. she denies fevers, diarrhea, cough, or dysuria. she was more confused today, making secret phone calls, having outbursts of yelling, and asking for the car keys but not saying where she is going. the family brought her into the ed. she was claiming that she didn't recognize her parents, that her parents were not her parents and that they were trying to hurt her. upon arrival to the ed, her vs were 98.1 69 16 117/63 100% on ra. she was complaining of an intermittent headache and hysterically crying at the same time. her exam was initially nonfocal. she was tachycardic and profusely asking for water. she was uncooperative and combative, restrained by security, and was given 5 of haldol and 2 of ativan im. ct head was normal. in addition she was given 2mg of versed for an lp. during the lp, her sodium returned low at 123. lp results were pending at the time of transfer. she was given vanco, ceftriaxone, acyclovir with decadron 10mg to cover for bacterial meningitis. prior to transfer, she was arousable but sedated, with a foley in place draining clear urine. admission vitals: t98.1 hr 71 bp 128/72 rr 20 spo2 100% 2lnc. on arrival to the micu, she was sedated and fatigued. past medical history: migraine headaches menometrorrhagia social history: completed masters program in economics in , prior to starting her position as an investment consultant in . denies tobacco, drug use with infrequent etoh. never sexually active. mother is md (trained as family practitioner), working in public health. father is trained as an atttorney. family history: mother and maternal side with history of migraines. physical exam: admission exam vitals: 98.3 91 119/71 20 99% on ra general: alert, oriented, no acute distress, quiet and noding off at times, flat affect heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops lungs: ctab, no wheezes, rales, ronchi abdomen: +bs, soft, non-tender, non-distended ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities discharge exam general: alert, oriented, no acute distress, pleasant and conversant heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops lungs: ctab, no wheezes, rales, ronchi abdomen: +bs, soft, non-tender, non-distended ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities pertinent results: admission labs: 03:15pm blood wbc-5.8 rbc-3.59* hgb-11.0* hct-32.0* mcv-89 mch-30.5 mchc-34.2 rdw-13.1 plt ct-241; neuts-86.2* lymphs-9.5* monos-3.9 eos-0.2 baso-0.2 07:30pm blood wbc-7.2 rbc-3.68* hgb-11.4* hct-32.7* mcv-89 mch-31.1 mchc-34.9 rdw-13.1 plt ct-244; neuts-92.4* lymphs-5.4* monos-1.9* eos-0.2 baso-0.2 03:15pm blood glucose-114* urean-5* creat-0.6 na-123* k-2.5* cl-85* hco3-23 angap-18 07:30pm blood glucose-127* urean-4* creat-0.6 na-130* k-3.2* cl-96 hco3-24 angap-13 11:30pm blood na-137 k-3.7 cl-102 09:09am blood alt-17 ast-43* ld(ldh)-234 alkphos-32* totbili-0.5 07:30pm blood calcium-8.3* phos-3.3 mg-1.5* 11:30pm blood calcium-9.0 mg-2.6 iron-53 11:30pm blood caltibc-303 ferritn-19 trf-233 09:09am blood vitb12-972* folate-17.7 07:30pm blood osmolal-265* 11:30pm blood tsh-1.1 05:40pm blood cortsol-24.4* (after cosyndtropin stim) 04:11pm blood cortsol-6.1 04:00am blood cortsol-0.8* 05:40pm blood hiv ab-negative 03:15pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 11:59pm blood type- temp-36.8 ph-7.40 03:18pm blood lactate-2.8* 11:59pm blood freeca-1.21 04:48pm cerebrospinal fluid (csf) wbc-1 rbc-1* polys-6 lymphs-85 monos-9 04:48pm cerebrospinal fluid (csf) totprot-22 glucose-68 discharge labs: 09:10am blood wbc-7.5 rbc-3.83* hgb-11.7* hct-35.2* mcv-92 mch-30.4 mchc-33.1 rdw-13.2 plt ct-259 glucose-81 urean-9 creat-0.8 na-142 k-3.9 cl-107 hco3-25 angap-14 calcium-8.9 phos-3.4 mg-2.1 06:28pm blood lactate-1.4 micro: crypto ag: neg blood cx: pnd csf cx (bacterial, afb, fungal): neg/prelim rpr: negative imaging: ct head: no acute process ekg: sinus rhythm. non-specific st-t wave changes in leads v2-v3. no previous tracing available for comparison. us pelvis: impression: limited pelvic ultrasound. no son abnormality detected on transabdominal examination. mri: impression: grossly normal examination, specifically without apparent etiology to altered mental status. brief hospital course: ms. was admitted to the icu for treatment of symptomatic hyponatremia and was treated as below for her active medical problems. after correction of hypona, pt was transfered to cc7 for a brief course, after which she was discharged. pt and mother requested to fu mri results on outpatient basis and, having been cleared by psychiatry, pt was discharged. active issues: # hyponatremia: hypotonic with patient appearing euvolemic on exam. most likely psychogenic polydipsia given profound history of water intake and reports of paranoia. her urine lytes urine osmolarity and her serum osmolarity were low as well. although urine osm were 120 (vs <100 expected for psychogenic polydypsia), the pt may have been on fluids at the time of the exam. siadh is on ddx (and can co-present in pts with psychosis and psychogenic polydypsia, although pelvic us negative for mass, cxr not available). pt's hyponatremia improved with fluid restriction after 1l 3% normal saline. additional testing done on admission: tsh wnl, cortisol stim test appropriate, infx (csf culture prelim, crypto, blood culture no growth to date, negative ua) unlikely, tox screen negative. pelvic us negative for mass and head ct/mri unremarkable. lp results unremarkable. pt was evaluated by psychiatry, who remakred that acute psychosis in ed was hyponatremia. further evaluation is necessary re. pt's initial paranoid behavior. - consider cxr if concern for malignancy causing siadh - consider measuring acth, as below - pls consider porphyrins (or png deaminase) if repeat episode in pt with hyponatremia and psychosis - pls follow up pt's paranoia - fu blood cx - fu final csf cx # paranoia vs somebody really stealing her facebook account. psychiatry was consulted who were not completely convinced this was new presentation of manic or pyschotic disorder. they will continue to follow her clinically. # low am cortisol with normal stim test. this rules out primary adrenal insuffiency, however primary adrenal insufficiency and low acth remains a possibility. the patient should get endocrine follow up for this. -endo follow up -consider measureing acth # altered mental status: most likely secondary to hyponatremia vs possible undiagnosed psychiatric illness. tox screens negative except for urine benzos which is likely a result of benzo administration in the ed. ct head showed no acute intracranial process. she was on iv acyclovir with low clinical suspicion it was discontinued and herpes pcr negative. - fu csf lyme titer # headaches: worsening in setting of stress. be migraines versus rebound headache. no headaches at time of discharge. transitional issues: - fu pt's mental status (concern for delusional disorder vs. schizophrenia) - pls re-eval pt's serum sodium - consider cxr if concern for malignancy causing siadh - consider measuring acth, as below - pls consider porphyrins (or png deaminase) if repeat episode in pt with hyponatremia and psychosis - possibility of aip - pls eval if pt was menstruating prior to onset of polydypsia (if aip, pt would be more likely to be symptomatic at time of blood loss) - fu blood cx - fu final csf cx medications on admission: excedrin migraine aspirin prn discharge medications: 1. aspirin-caffeine-butalbital cap po prn headahce headache discharge disposition: home discharge diagnosis: hyponatremia altered mental status discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to care for you in the hospital. . you were brought to the hospital after being confused. you were found to have a low sodium level in your blood. this was corrected over your hospital stay. we think this was caused by drinking too much water, other causes were ruled out by several blood tests. you had an mri of the head. we discussed with you staying here until the radiologists had completed interpretation of the mri. you were unable to stay in the hospital. we will call you with the results of the mri. no changes were made to your home medication list. . please do not drink excess amounts of water. . please follow up with your primary care physician in the next 1 week followup instructions: department: medical group when: monday at 3:45 pm with: dr. building: (, ma) campus: off campus best parking: on street parking department: medical specialties when: thursday at 3:20 pm with: , md building: sc clinical ctr campus: east best parking: garage ****your insurance records are incomplete- please call our registration department at ( before your first appointment. if you do not have any insurance listed, you may be required to pay up front for these visits. procedure: spinal tap incision of lung diagnoses: hypocalcemia hyposmolality and/or hyponatremia hypopotassemia disorders of phosphorus metabolism migraine, unspecified, without mention of intractable migraine without mention of status migrainosus delirium due to conditions classified elsewhere 

Answer: The patient is high likely exposed to