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 known allergies / adverse drug reactions attending: chief complaint: sob, dizziness, weakness major surgical or invasive procedure: large volume paracentesis hemodialysis history of present illness: briefly, mr. is a 64 y/o m with cad, mi to cocaine use, dm, esrd on hd, polysubstance abuse, and cirrhosis who presented to the ed with severe electrolyte abnormalities in the setting of missing hd x 3 weeks. the patient presented to the ed where he c/o sob, dizziness, weakness. had hyperkalemia to 7.4, hyponatremia to 126, bun 203 and cr 23.8. went into wide complex tach and went to icu where he was emergently dialyzed. patient also found to have aflutter in the micu and seen by cards who are planning for ablation. cardiology and ep was consulted and planned for ablation on friday. on labetalol and nifedipine for rate control. tte pending. myo/pericarditis mb 15 friday should go for early dialysis and then ablation. ?sbp in ed but no overt signs of infection, abdominal exam benign. past medical history: diabetes- neuropathy, microalbuinuria alcohol abuse cocaine abuse- drug free since anemia back pain- central and right paracentral disc herniation compressing the thecal sac with moderate central canal stenosis and compression right l4. ckd- on dialysis cad hyperlipidemia hypertension social history: per psych) recent homelessness leading to living at the homeless shelter, multiple chronic medical problems, living away from his wife and kids, and unemployment. the patient has a remote history of cocaine dependence and alcohol dependence which he refused to elaborate on. the patient was born and raised in by both of his parents. he has 5 brothers, 4 sisters, and 2 children with his wife. currently, his wife and children reside in . mr. states that he is religious and that god was the main reason that "i am still here today". he completed the 9th grade and would not reveal any other information about his social history. family history: one brother with mi at age 54, multiple siblings with dmii. father died of lung ca in his 60's. diabetes in his mother, brother, and sisters along with hypertension. no history of renal disease. physical exam: admission exam: gen: nad, awake, alert vs: t 99.7 bp 162/101 hr 110 rr 18 sat 96% ra neck: no jvd cv: rrr, no murmurs, no rub. pulm: crackles at b/l bases abd: soft, distended, mildly tender to palpation ext: wwp, no edema ble discharge exam: 98.3 143/85 95-112 18 97% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, regular rate, normal s1 + s2, ii/vi sem, rubs, gallops lungs: bilateral inspiratory rhonchi improved, no wheezes, rales. abdomen: soft, minimally tender to deep palpation, distended, bs+, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. pertinent results: admission labs: 12:40pm wbc-8.8 rbc-3.65* hgb-11.2* hct-33.9* mcv-93 mch-30.6 mchc-32.9 rdw-14.8 12:40pm neuts-87.7* lymphs-7.1* monos-4.3 eos-0.8 basos-0.2 12:40pm plt count-316 12:40pm ck-mb-20* mb indx-6.3* probnp-greater th 12:40pm ctropnt-0.59* wbc rbc polys lymphs monos eos mesothe macroph other 16:44 186* 36* 10* 3* 0 13* 74* blood cx x 2 from : ngtd imaging: ekg : atrial flutter with 3:1 and 4:1 conduction with a single, likely aberrantly conducted beat versus a ventricular premature beat. borderline low limb lead qrs amplitude. there are likely diffuse repolarization abnormalities which are distorted and accentuated by the underlying flutter waves. compared to the previous tracing of , computed frontal plane axis is no longer rightward. criteria for left ventricular hypertrophy are no longer fulfilled. t wave inversions in the left precordial leads are unchanged, accounting for differences in electrode placement. an ongoing lateral ischemic process cannot be excluded. clinical correlation is suggested. presence of inferior flutter waves makes excluding inferior ischemia difficult. echo (tte) : the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-5 mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is akinesi and thinning of the basal inferior septum. the remaining segments contract normally. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. the main pulmonary artery is dilated. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , pulmonary pressures are higher. other findings are similar. there is no significant pericardial effusion. discharge labs: 08:45am blood wbc-8.2 rbc-2.80* hgb-8.6* hct-25.9* mcv-92 mch-30.5 mchc-33.1 rdw-14.4 plt ct-250 08:45am blood plt ct-250 08:45am blood glucose-142* urean-38* creat-5.7*# na-137 k-3.9 cl-100 hco3-25 angap-16 01:20pm blood pt-12.1 ptt-35.4 inr(pt)-1.1 08:45am blood calcium-8.5 phos-2.7# mg-1.9 brief hospital course: mr. is a 64 year old man with a history of cad, mi secondary to cocaine use, htn, hyperlipidemia, dm, esrd, polysubstance abuse, and cirrhosis who presented to the ed with progressive weakness, dyspnea, and dizziness in the setting of not going to hemodialysis for the past 3 weeks. #electrolyte abnormalities: on admission, patient with metabolic acidosis with anion gap of 40 in setting of missing dialysis for past 2-3 weeks. labs notable for hyponatremia (126), hyperkalemia (7.4), bun of 203, and cr 23.8. he did have ecg notable for widening qrs on interval studies. he was given 3 amps of calcium gluconate, insulin/dextrose and ecg normalized. he was emergently dialyzed with normalization of electrolytes. he was restarted on his home sevelamer and calcium acetate. he continued to undergo hd daily and his electrolytes slowly improved prior to d/c. he will resume hd at on his normal dialysis schedule upon discharge. #atrial flutter: following first dialysis session, pt was found to be in a-flutter with a hr of 150. he was rate contolled on labetalol. cardiology consult saw patient and believed he would benefit from ablation. however, because the patient admitted that he may not be able to adhere to ac. if can show compliance by coming to cardiology f/u as outpatient, then ablation and ac will be considered. his rate control was switched to metoprolol and nifedipine as the patient was hypotensive with the combination of labetalol and nifedipine on the regular floor. #pericarditis: pt promotes cp and sob prior to admission but states it has resolved. per cardiology consult, he had a pericardial rub in ed and ecg was consistent with pericarditis with st-segment elevations in v2-v4 and diffuse pr depressions. given patients elevated bun of 206, most likely uremic pericarditis. vital not concerning for tamponade or constrictive physiology. his uremia resolved with dialysis and he did not require nsaids for pain. a tte showed trivial pericardial effusion. # anemia - patient had hct drop overnight from 32.8 -->24.5. no signs of active bleeding on exam today, abdominal exam unchanged from prior. patient endorses abdominal pain in setting of being hungry but no continued pain after eating. anemia likely to poor nutritional status and and chronic kidney disease with poor epo production. also be bone marrow suppression if patient is continuing to consume alcohol although he denies it. he received iron iv and epoietin infusion during dialysis. his hcts were trended and continued to be stable. #cad: pt notes some chest pain and sob in days prior to admission but pt not complaining of any cp on arrival. pt does have elevated troponin on admission but believed to be secondary to renal failure. st elevations in leads v2-5 thought to be secondary to pericarditis. pr depressions and rub on pe coorbarated this diagnosis. he was started on home asa, valsartan, nifedipine, labatalol. serial ecgs showed a-flutter with resolution of st elevations. cardiac enzymes downtrended from admission. a tte showed moderately dilated la/ra, moderate symmetric lvh with ef >55%. there is akinesis and thinning of the basal inferior septum. mildly dilated rv with borderline normal free wall function. trivial mr, moderate ar, moderate pulmonary artery systolic hypertension with dilation of main pulmonary artery, and trivial/physiologic pericardial effusion #cirrhosis: pt has cirrhosis most likely etoh. last theraputic paracentesis in 6/. ruq us in notable of cirrhosis with no potal vein abnormality. physical exam consistent was consistent with ascities this admission. no fever or elevated wbc to indicate sbp. he underwent therapeutic thoracentesis of 5l with no evidence of sbp on peritoneal fluid analysis. #dm: on admission to micu, held home nph and started on humolog sliding scale. #social work: pt has missed several hd sessions in the past and was seen by social work. sw receives return call from , sw on dialysis unit. explains that it would be very difficult to change pt. to another shift since that could only happen if he traded slots with another pt. pt. has a history of non-compliance with dialysis, both at and at prior facility, da vita. is reluctant to work out a trade with another pt. as this will be an inconvenience for this other pt. and may be done in vain if pt. continues to be non-compliant. sw receives return call from d&g towing (). they agree to waive some of pt's car's storage fees. they request that pt. come to retrieve his car at discharge which is anticipated for tomorrow. -sw fax'es a letter to towing company confirming pt's presence in hospital. medications on admission: the preadmission medication list may be inaccurate and requires futher investigation. 1. valsartan 320 mg po daily 2. labetalol 400 mg po bid discharge medications: 1. aspirin 325 mg po daily 2. atorvastatin 40 mg po daily 3. calcium acetate 1334 mg po tid w/meals 4. isosorbide mononitrate (extended release) 60 mg po daily 5. metoprolol succinate xl 100 mg po daily rx *metoprolol succinate 50 mg 3 tablet(s) by mouth daily disp #*90 tablet refills:*0 6. lorazepam 0.5 mg po hs:prn insomnia 7. nifedipine cr 90 mg po daily 8. nitroglycerin sl 0.3 mg sl prn chest pain 9. omeprazole 40 mg po daily 10. oxycodone-acetaminophen (5mg-325mg) tab po q6h:prn pain 11. sevelamer carbonate 1600 mg po tid w/meals 12. nph 15 units breakfast 13. nephrocaps 1 cap po daily discharge disposition: home discharge diagnosis: electrolyte abnormalities esrd on dialysis atrial flutter cirrhosis 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: it was a pleasure taking care of you at ! you were admitted due to electrolyte abnormalities that happened because of missing your dialysis. you were in the intensive care unit for a number of days being treated for an abnormal heart rhythym. you improved and were transferred to the general medicine floor to continue dialysis. you also had fluid in your abdomen drained. medication changes: - please stop valsartan. you can discuss re-starting this with your primary care doctor if your blood pressure improves. - please stop labetolol and replace it with metoprolol you continue to have an abnormal heart rhythym called atrial flutter. we do not believe this is dangerous right now but you need to follow-up with doctors as outpatient. weigh yourself every morning, md if weight goes up more than 3 lbs. your car is in a lot: dng towing ( followup instructions: department: internal medicine when: thursday at 11:00 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: liver center when: tuesday at 1:20 pm with: dr. building: lm campus: west best parking: garage department: cardiac services when: thursday at 2:40 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis percutaneous abdominal drainage diagnoses: hyperpotassemia end stage renal disease coronary atherosclerosis of native coronary artery alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission personal history of tobacco use depressive disorder, not elsewhere classified atrial flutter hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia unspecified disease of pericardium disorders of phosphorus metabolism old myocardial infarction other ascites noncompliance with renal dialysis other specified disorders resulting from impaired renal function diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled lack of housing acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to