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: heparin sodium attending: chief complaint: hyperglycemia, hypotension major surgical or invasive procedure: right subclavian line placed with no complications. history of present illness: mr. is a 60 year old male with history of alzheimer's dementia, non-verbal at baseline, htn, cad s/p 3v cabg, who was sent to the e.d. for findings of upper extremity rigidity and elevated glucose with critically high finger sticks. per discussion with the patient's wife, the patient has been increasingly lethargic over the last week, sleeping most of the day. yesterday, the patient was noted by his wife to have increasing twitches throughout his body, upper and lower, although of note different in characteristic than when he seizes. the patient is reported to have headaches (although non-communicative) without other localizing symptoms. patient not noted to have respiriatory distress or diarrhea. . ed course: vitals: 99.4 hr-96 bp-97/74 rr-20 o2: 100% in the e.d. the patient was placed on an insulin gtt for hyperglycemia. an ecg performed in the ed was revealing for anterior st depressions with twi. cardiology was consulted and performed a bedside echocardiogram. per ed report, initial interpretation was concerning for wall motion abnormalities although this was re-interpreted as none on second look. regardless, cardiology did not feel cardiac catheterization was warranted as the patient had already likely infarcted previously. given heparin allergy the patient was given asa and plavix loaded. during the ed course the patient became hypotensive with sbp to the 70s requiring fluid boluses, placement of a right subclavian line, and initiation of dopamine, 20mcg on transfer. . on arrival to floor patient is awake and alert, noted to be mildly agitated, with occasional few words but no meaningful communication. past medical history: presinilin mutation + alzheimer's disease htn mi s/p cabgx3 iddm chronic renal insufficiency social history: the patient was originally born in . previously worksed at in receiving, lives at home with wife and son. his wife feeds and clothes him. walks from bed to bathroom only tobacco: none etoh: previous use, quit 10 years ago illicits: none family history: two sisters and one brother with dementia physical exam: vitals: t-97.3 bp: 99/52 (20mcg/kg dopa) hr:117 rr: 17 o2: 97% on 2l nc cvp: 2 . general: the patient is a chronically ill appearing male, appears older than stated age, appears to be mildly agitated, moving arms frequently, some fasciculations in lower extremities heent: ncat, eomi. does not track to command op: mm mildy dry appearing, dry blood and chronic ulceration over distal tongue neck: supple, jvp at base of neck chest: few transmitted upper airway sounds, no rales, rhonchi, or wheezes although posterior exam limited cor: rrr, normal s1/s2. soft ii/vi early systolic murmur throughout precordium abdomen: soft, non-tender, non-distended. normal bowel sounds extremity: no c/c/e. dp 2+ bilaterally access: right subclavian, left a-line, foley pertinent results: 11:15am plt count-122* 11:15am wbc-8.4 rbc-5.46 hgb-10.5* hct-34.2* mcv-63* mch-19.3* mchc-30.9* rdw-16.1* 11:15am calcium-9.6 phosphate-5.3* magnesium-3.9* 11:15am ck-mb-7 ctropnt-0.41* 11:15am ck(cpk)-575* 11:15am glucose-869* urea n-132* creat-4.5*# sodium-141 potassium-5.1 chloride-98 total co2-30 anion gap-18 11:23am glucose-697* lactate-2.1* k+-4.8 11:30am pt-13.8* ptt-21.2* inr(pt)-1.2* 04:55pm urine blood-neg nitrite-neg protein-neg glucose-1000 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:55pm urine color-straw appear-clear sp -1.024 05:09pm k+-3.2* 06:05pm tsh-0.62 06:05pm albumin-3.9 06:05pm ctropnt-0.44* 06:05pm lipase-41 06:05pm alt(sgpt)-22 ast(sgot)-27 ld(ldh)-224 ck(cpk)-552* alk phos-96 amylase-79 tot bili-0.3 09:21pm urine hours-random urea n-871 creat-140 sodium-36 09:21pm calcium-8.9 phosphate-3.1# magnesium-3.4* 09:21pm glucose-79 urea n-114* creat-3.8* sodium-153* potassium-3.6 chloride-116* total co2-23 anion gap-18 10:20pm calcium-8.3* phosphate-3.2 magnesium-3.2* 10:20pm glucose-172* urea n-112* creat-3.7* sodium-148* potassium-3.7 chloride-114* total co2-21* anion gap-17 03:20am blood wbc-9.1 rbc-4.95 hgb-9.4* hct-29.4* mcv-59* mch-19.0* mchc-32.1 rdw-15.7* plt ct-100* 03:12am blood wbc-8.6 rbc-4.87 hgb-9.4* hct-29.1* mcv-60* mch-19.3* mchc-32.2 rdw-16.0* plt ct-102* 05:35am blood wbc-7.9 rbc-4.62 hgb-8.9* hct-27.5* mcv-60* mch-19.2* mchc-32.3 rdw-15.8* plt ct-84* 05:22am blood wbc-10.0 rbc-4.66 hgb-8.9* hct-27.6* mcv-59* mch-19.0* mchc-32.2 rdw-16.0* plt ct-90* 04:50am blood wbc-9.0 rbc-4.41* hgb-8.5* hct-26.0* mcv-59* mch-19.2* mchc-32.6 rdw-16.1* plt ct-101* 03:20am blood pt-13.1 ptt-21.2* inr(pt)-1.1 03:20am blood plt ct-100* 03:12am blood pt-13.7* ptt-22.8 inr(pt)-1.2* 03:12am blood plt ct-102* 05:35am blood pt-13.4* ptt-22.2 inr(pt)-1.2* 05:35am blood plt ct-84* 05:22am blood pt-12.5 ptt-23.1 inr(pt)-1.1 05:22am blood plt ct-90* 04:50am blood plt ct-101* 03:20am blood glucose-248* urean-102* creat-3.2* na-148* k-3.3 cl-114* hco3-22 angap-15 03:12am blood glucose-151* urean-59* creat-2.2* na-151* k-4.0 cl-116* hco3-26 angap-13 05:35am blood glucose-183* urean-40* creat-1.7* na-144 k-3.9 cl-110* hco3-25 angap-13 05:22am blood glucose-135* urean-33* creat-1.7* na-142 k-4.0 cl-109* hco3-24 angap-13 04:50am blood glucose-224* urean-33* creat-1.7* na-140 k-4.4 cl-106 hco3-28 angap-10 03:20am blood ck(cpk)-488* 03:20am blood ck-mb-11* mb indx-2.3 ctropnt-0.24* 03:20am blood calcium-8.3* phos-3.1 mg-3.2* cholest-115 03:12am blood calcium-9.0 phos-2.8 mg-2.9* 05:35am blood calcium-8.5 phos-2.8 mg-2.3 05:22am blood calcium-8.2* phos-3.6 mg-2.1 03:20am blood triglyc-201* hdl-23 chol/hd-5.0 ldlcalc-52 . ecg: sinus rhythm left atrial abnormality consider left ventricular hypertrophy anterolateral st-t abnormalities - cannot exclude in part ischemia - clinical correlation is suggested. since previous tracing of the same date, no significant change . cxr: no acute cardiopulmonary disease. . ct head: impression: 1. no hemorrhage, mass effect, or edema. 2. moderate central atrophy. . echo: conclusions: the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic, although the posterior wall appears to contract in a dyssynchronous fashion. there is no ventricular septal defect. right ventricular chamber size is normal. right ventricular systolic function appears depressed. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. lvef > 75%, hyperdynamic. brief hospital course: hospital day#1(): patient admitted to micu for hypotension (sbp 70's) in the er of sudden onset. right subclavian line placed and dopamine drip started at 20 mcg/hr in ed. patient likely presented with dehydration/hypovolemia secondary to non-ketotic hyperosmolar state and patient noted to be profoundly hyperglycemic with bg 869 and glycosuria. hypotension secondary to cardiogenic shock also on the differential due to ?recent mi, but cvp found to be decreased. low suspicion of sepsis due to lack of temperature and normal lactate. patient was treated with aggressive fluid resuscitation and insulin ggt. patient afebrile on presentation but had increased "twitching"/rigors and was pancultured. all blood culture and urine culture results were subsequently negative. home anti-hypertensives were held upon admission. subsequent hospital course by problem: #. hyperglycemia - there was no anion gap on presentation, seemed more consistent with hyperosmolar non-ketosis, likely in setting of recent possible nstemi and poor po intake. patient had been receiving home meds as prescribed per his wife. was placed on insulin drip on admission, which was taken off insulin ggt . he was loaded with lantus 25 u hs. endocrinology fellow consulted for managen of glucose levels which were relatively under control on the medical floor- 100's to 250's. pt is currently on humalog sliding scale and lantus 35 units at bedtime. sliding scale has been adjusted on and recommendations, patient was given sliding scale instructions on discharge. blood glucose levels should continue to be monitored four times per day per sliding scale and insulin should be adjusted at nursing home as needed. # thrombocytopenia - pt with thrombocytopenia during micu course, nadir at 84, currently at 163. in the micu, concern was for hit given heparin allergy and possible heparin coated central line. since transfer to the medical floor, the platelets are trending up, so hit unlikely, possibly due to fluid load in the micu. #. hypotension - patient unable to provide symptoms. the differential is most likely hypovolemia secondary to non-ketotic hyperglycemia in setting of poor po intake and insulin dependent diabetic. consideration as well for cardiogenic etiology although cvp was not elevated. sepsis was not a concern given fact that patient was afebrile and blood cultures were negative. since transfer to the medical floor, mr. blood pressures have been stable with sbp 130's to 140's and dbp 60's to 80's. we have adjusted his blood pressure medication regimen, furosemide has been discontinued secondary to acute renal failure on presentation and norvasc was decreased from 10mg daily to 5mg daily. mr. is to follow up with his pcp for follow up on his blood pressure and review of his medications. #. elevated - pt with elevated on admission, possibly secondary to nstemi prior to admission - not acute. however, pt also with acute renal failure on admission which distorts the picture. elevated cardiac enzymes can also be increased during renal failure. however, ecg with st depressions and t wave inversions which suggests a cardiac event. cardiology consulted and decided against cardiac catheterization as nstemi was not considered acute, likely occurred prior to admission. pt has been medically managed. will continue with asa, lipitor, avapro, labetalol on discharge. #. arf/ckd - patient admitted with a cr of 4.5, baseline around 2.0. on admission, patient thought to be hypovolemic. pt was treated in the micu and volume resuscitated. upon transfer to the medical floor, cr has stabilized to baseline - cr 2.0 on . # sacral decubitus ulcer - pt noted to have stage ii sacral decubitus ulcer on transfer from micu. as patient was only in the icu for a few days, it is unlikely that this ulcer began in the hospital. he is being treated with duoderm patches q3days. last change today, . wound care to continue at nursing home. #. seizure disorder - patient with history of seizure disorder. no seizures have been noted while in the hospital. pt sometimes has jerking movements while being examined but seems volitional in nature, pt is responsive and smiling with these movements. pt to continue with outpatient depakote. #. alzheimer's - continue memantine, vitamin e. medications on admission: aranesp 40mcg every other week memantine 10mg/5ml twice daily depakote sprinkles 250mg qam, 500mg qpm avapro 75mg daily hctz 25mg po daily labetolol 150mg furosemide 40mg daily norvasc 10mg daily flomax 0.4mg daily lipitor 10mg daily asa 325mg daily novolog 5u ac meals lantus 5u in the evening calcitriol 0.25mcg daily mvi daily vitamin e 400u daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. memantine 5 mg tablet sig: two (2) tablet po bid (). 3. hexavitamin tablet sig: one (1) cap po daily (daily). 4. vitamin e 400 unit capsule sig: one (1) capsule po daily (daily). 5. lipitor 10 mg tablet sig: one (1) tablet po at bedtime. 6. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 7. divalproex 125 mg capsule, sprinkle sig: two (2) capsule, sprinkle po qam (once a day (in the morning)). 8. divalproex 125 mg capsule, sprinkle sig: four (4) capsule, sprinkle po qhs (once a day (at bedtime)). 9. labetalol 100 mg tablet sig: 1.5 tablets po bid (2 times a day): please hold for sbp < 100, hr < 60. 10. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily): please hold for sbp < 100. 11. norvasc 5 mg tablet sig: one (1) tablet po once a day: hold for sbp < 100. 12. avapro 75 mg tablet sig: one (1) tablet po once a day: hold for sbp < 100. tablet(s) 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous sliding scale: please follow attached sliding scale instructions. 16. insulin glargine 100 unit/ml solution sig: one (1) 35u subcutaneous at bedtime. 17. flomax 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 18. duoderm patch wound care: pt with stage ii sacral decubitus ulcer. treat with duoderm patch q3days. last change . discharge disposition: extended care facility: - discharge diagnosis: primary: hyperosmolar non-ketosis non-st elevation myocardial infarction . secondary: coronary artery disease - s/p mi, cabgx3 alzheimer's diabetes mellitus type 2 chronic kidney disease anemia of chronic disease hypertension hyperlipidemia seizure disorder discharge condition: stable discharge instructions: you were admitted to the hospital for a diabetic emergency. your glucose levels were dangerously high above 800 on admission. this is thought to have been caused by a heart attack which ocurred prior to your visit to the emergency room. you were seen by cardiology who recommended medical management for your event. you also had an episode of low blood pressure while in the emergency room , which is thought to be due to dehydration. you were sent to the medical intensive care unit for rehydration and management of your blood pressure. your pressure and fluid balance stabilized while in the intensive care unit and you were transferred to the medical floor. we have discontinued your furosemide and decreased your norvasc from 10mg daily to 5mg daily. otherwise, you are to continue with your regular doses of your remaining blood pressure medication (hydrochlorothiazide, labetolol, avapro). you have been seen by the endocrinologists at for management of your blood glucose levels. you are to take 35units of lantus at night. you have also been placed on an insulin sliding scale, please follow the attached directions. you were also noted to have a stage ii sacral decubitus ulcer while in the hospital. this occurs from prolonged bedrest. we have treated this with duoderm patches. please continue with duoderm patches, which you will change every 3 days. you should not remain in bed for prolonged periods of time, if you are in bed please be sure to change positions to lie on your left and right side of the body. you should also sit in a chair during the day and walk with assistance. if you experience chest pain, palpitations, jaw pain, arm pain, shortness of breath, nausea, vomiting, fainting, dizziness or any other concerning symptom then please call your doctor or report to the nearest emergency room. please continue with your remaining outpatient medications unless otherwise stated above. please attend your follow up appointments listed below. followup instructions: provider: , md phone: date/time: 4:20 provider: . phone: date/time: 2:30 provider: , m.d. phone: date/time: 9:30 md procedure: venous catheterization, not elsewhere classified infusion of vasopressor agent diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease subendocardial infarction, initial episode of care acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status chronic kidney disease, unspecified other and unspecified hyperlipidemia other shock without mention of trauma old myocardial infarction pressure ulcer, lower back epilepsy, unspecified, without mention of intractable epilepsy alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hypovolemia diabetes with hyperosmolarity, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to