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: penicillins / zantac / morphine / tylenol / naprosyn / ketorolac / potassium attending: chief complaint: chest pain and hypotension major surgical or invasive procedure: none. history of present illness: this is a 45 year-old female with a pmh hypotension on florinef, esrd, dmii, and borderline personality disorder, who presents with complaints of chest pain that began yesterday during dialysis. pain localizes without radiation to the left upper quadrant of the chest. it is stabbing in nature. she denied any fevers at home. she did complain of nausea and 1x emesis yesterday. her cp recurred, therefore she was brought to the ed. she has a history of hypotension which was worked up by endocrine last admission. it was thought to be dysautonomia. of note she had an admission to the icu 2 weeks ago with the same presentation, and was started on levophed in the ed, but was quickly weaned in the icu given her known hypotension. . ed course: she was hypotensive to the 80s and symptomatic with lightheadedness. she was given 1.25l of ivf and her bp responded to the 100s. she was given 1g of vanco and 4.5g of zosyn out of concern for infection. her pain was treated with 0.5mg iv dilaudid. . on the floor, she was awake and sitting up drinking a large glass of water. she was asymptomatic and denied fevers, chills, chest pain (currently), sob, cough, diarrhea, rhinorrhea, myalgias, sore throat or any vaginal complaints. past medical history: 1. hypotension (likely mineralocorticoid deficient, hypo-renin, hypo-aldosterone, not likely complete adrenal insufficiency vs. autonomic dysfunction on florinef) 2. esrd on hd m/w/f (rue av-fistula) 3. type 2 diabetes mellitus 4. coronary artery disease (inferior mi, cardiac cath , ef 65%, inferior hypokinesis; mibi no perfusion defects, no ischemic st changes) 5. h/o lle dvt (no longer on coumadin), popliteal dvt () s/p ivc filter placement 6. hypertension 7. gerd 8. h/o positive mrsa swab () 9. hyperlipidemia 10. chronic abdominal pain (no etiology identified, extensive work-up including mra abdomen, strongyloides serologies, ruq u/s, multiple kubs) 11. borderline personality disorder 12. drug-seeking behavior, ? suicidality 13. left eye prosthesis (followed by ophthalmology at ) 14. bilateral ij and sc dvts social history: social history: born in and moved from ; divorced, has two daughters. worked as a cna. now resides in long term care facility. - tobacco: denies - alcohol: denies - illicits: denies family history: mother died from diabetes complications, brother died from the same as well; sister and daughter have diabetes. physical exam: admission exam: vitals: t: 96.9 bp: 125/71 p: 85 r: 16 o2: 98% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, left eye prosthesis neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops, non-tender to palpation, 2 cm sebaceous cyst in center chest abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge exam: vitals: t 99.3, bp 127/63, p 84, r 20, 100% ra gen: nad, a&ox3. heent: prosthetic l eye, reactive right pupil, mmm cards: rrr s1/s2 heard. holysystolic ejection murmur, no gallops/rubs. chest: l breast larger than right, and l firmer than right, but non ttp pulm: ctab abd: soft, nt nd, +bs. no organomegaly. extremities: no edema, no rashes/discoloration. skin: warm and dry pertinent results: admission labs: 04:35pm blood wbc-5.3 rbc-4.49 hgb-14.0 hct-42.2 mcv-94 mch-31.1 mchc-33.1 rdw-18.6* plt ct-195 04:35pm blood neuts-68.0 lymphs-19.4 monos-5.8 eos-6.2* baso-0.6 04:35pm blood pt-12.8 ptt-28.3 inr(pt)-1.1 04:35pm blood glucose-216* urean-22* creat-6.9*# na-137 k-4.6 cl-92* hco3-31 angap-19 04:35pm blood ctropnt-0.05* . 04:50am blood ck-mb-3 ctropnt-0.04* 04:50am blood lipase-23 . discharge labs 12:16pm blood wbc-3.4* rbc-3.47* hgb-10.9* hct-33.2* mcv-96 mch-31.4 mchc-32.8 rdw-19.0* plt ct-167 12:16pm blood neuts-52.6 lymphs-30.6 monos-5.6 eos-10.7* baso-0.4 12:16pm blood glucose-251* urean-32* creat-9.1*# na-133 k-4.3 cl-91* hco3-32 angap-14 12:16pm blood calcium-9.0 phos-4.6* mg-2.9* iron-48 12:16pm blood caltibc-200* ferritn-570* trf-154* 04:50am blood hgb a-pnd hgb s-pnd hgb c-pnd . cxr single ap upright portable view of the chest was obtained. there are relatively low lung volumes, which accentuate the bronchovascular markings. given this, no focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. the cardiac and mediastinal silhouettes are unremarkable. right-sided vascular stent is unchanged. cardiac and mediastinal silhouettes are stable. impression: no acute cardiopulmonary process. brief hospital course: 45 year old female with pmh of pmh hypotension on florinef, esrd, dmii, and borderline personality disorder, who presents with complaints of chest pain, hypotension, fluid responsive in the ed. . acute hypotension: likely secondary to agressive dialysis, as had hd the day prior to admission and uf the day of admission. she was fluid responsive in the ed and admitted to the micu for close observation. she was afebrile and without any other symptoms or signs concerning for infection. in the icu, she required no further fluids and maintained a sbp 80s-100s, which appears to be her baseline. home florinef was continued. she was called out to the medical floor after being observed in the icu overnight. pt did not need any fluids while on the floor and tolerated 1 kg removal with dialysis on . . chest pain: etiology was unclear, though most likely to be gastrointestinal in nature as patient had relief of symptoms with maalox-lidocaine. cardiac source was considered, and thought to be highly unlikely given that her ekg (including right-sided lead ekg) was unchanged from prior, troponin measurements were less than baseline (though higher than normal given her esrd) and had normal ckmb. cardiology reviewed her ekgs and did not see evidence of ischemia. sickle cell acute chest was considered, though it is less likely given her absence of anemia and lack of history, but hemoglobin electrophoresis is currently pending. pulmonary embolism is also unlikely given the absence of tachycardia and hypoxia, though she does have a history of dvt with a filter in place. pt had refused heparin in-house and was educated on the risks of this and pt understood this can cause clots in the lungs that can lead to death. pulmonary embolism was considered unlikey to explain her symptoms. she was continued on her home asa, statin, and her home pain regimen of po dilaudid. iv dilaudid and iv benadryl were requested by the patient and were not given. . esrd: currently getting hemodialysis on monday, wednesday, friday. pt had no acute electrolyte abnormalities. had dialysis while in-house on and . she was continued on sevelamer and vitamins. dr. , who is her outpatient nephrologist was aware of admission and saw her while in-house. . dmii: pt with labile finger stick blood sugars. very high levels (400s) in the morning while on lantus 6 units at night and so was increased to 12 units for more adequate basal coverage. pt on levemir at home, but placed on glargine while in house. pt had episodes of very low blood sugars after administration of insulin via the sliding scale so was titrated down. after adjusting the lantus and her , pt had better glucose control. after discharge, her finger stick glucose should be closely monitored and insulin regimen adjusted accordingly. . breast swelling: pt had new complaints of left breast swelling on the day of discharge, report it felt bigger and firmer than her right, which she has never experienced before. physical exam did not demonstrate any erythema, warmth, lumps, or any evidence of an abscess. she has a history of left subclavian vein occlusion and collaterals from the right and thrombus in the right innominate vein graft, mild breast assymetry is likely related to increased interstitial fluid in the left breast. further evaluation with age-appropriate screening is recommended. . chronic psych: continued quetiapine. . eye irritation: continued home latanoprost. discontinued tobramycin-dexamethasone seh was discharged with opthalmology followup as she has not been seein in >2 years. . gerd: continued omeprazole 20mg . transitional # recommend follow-up with primary care doctor to review medication list, diabetes management, and for follow-up of the hemoglobin electrophoresis. . # recommend follow-up with nephrologist to monitor esrd medications. . # recommend further evaluation of left breast swelling and age-appropriate screening. medications on admission: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 3. dicyclomine 10 mg capsule sig: two (2) capsule po qid (4 times a day). 4. erythromycin 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po tid (3 times a day). 5. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 6. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 10. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 11. tizanidine 2 mg tablet sig: 0.5 tablet po hs (at bedtime). 12. hydromorphone 2 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 13. lorazepam 1 mg tablet sig: one (1) tablet po every six (6) hours as needed for anxiety. 14. quetiapine 50 mg tablet sig: one (1) tablet po hs (at bedtime). 15. tobramycin-dexamethasone 0.3-0.1 % ointment sig: one (1) appl ophthalmic tid (3 times a day). 16. polyethylene glycol 3350 17 gram/dose powder sig: one (1) powder po daily (daily) as needed for constipation. 17. levemir 100 unit/ml solution sig: six (6) units subcutaneous at bedtime. 18. insulin aspart 100 unit/ml solution sig: sliding scale sliding scale subcutaneous every six (6) hours. 19. fludrocortisone 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 20. dilaudid 2 mg tablet sig: 0.5 tablet po 3 times weekly: m/w/f on hd days. 21. bisacodyl 10 mg suppository sig: one (1) supp rectal at bedtime as needed for constipation. 22. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po every six (6) hours as needed for constipation. 23. bisacodyl 5 mg tablet sig: two (2) tablet po once a day as needed for constipation. 24. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po every six (6) hours as needed for itching. 25. lorazepam 1 mg tablet sig: one (1) tablet po m/w/f: three times weekly. 26. aranesp (polysorbate) 40 mcg/0.4 ml syringe sig: forty (40) mcg injection once a week. 27. gabapentin 100 mg capsule sig: one (1) capsule po at bedtime. discharge medications: 1. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 4. dicyclomine 10 mg capsule sig: two (2) capsule po qid (4 times a day). 5. erythromycin 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po tid (3 times a day). 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 10. latanoprost 0.005 % drops sig: one (1) drop(s) in each eye ophthalmic hs (at bedtime). 11. lorazepam 1 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 12. quetiapine 50 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 13. fludrocortisone 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 14. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for itching. 15. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). 16. hydromorphone 2 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain for 3 days. disp:*6 tablet(s)* refills:*0* 17. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 18. tizanidine 2 mg tablet sig: 0.5 tablet po at bedtime. 19. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po once a day. 20. dilaudid 2 mg tablet sig: 0.5 tablet po three times weekly for 3 doses: m/w/f on hd days. disp:*3 tablet(s)* refills:*0* 21. bisacodyl 10 mg suppository sig: one (1) suppository rectal at bedtime as needed for constipation. 22. lorazepam 1 mg tablet sig: one (1) tablet po three times weekly: m/w/f on hd days. 23. aranesp (polysorbate) 40 mcg/0.4 ml syringe sig: one (1) syringe injection once a week. 24. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea for 4 doses. disp:*4 tablet, rapid dissolve(s)* refills:*0* 25. maalox maximum strength 400-400-40 mg/5 ml suspension sig: 10-20 mls po twice a day as needed for abdominal/chest pain for 1 doses. 26. humalog (subcutaneous) 100 unit/ml solution. humalog (subcutaneous) 100 unit/ml solution. sig: dispense qam, qnoon, and qpm according to the following scale: bg <150: no coverage bg 150-199: 2 units, bg 200-249: 4 units, bg 250-299: 6 units, bg 300-349: 8 units, bg over 350: 10 units, at bedtime use the following scale bg <150: no coverage bg 150-199: 0 units, bg 200-249: 2 units, bg 250-299: 4 units, bg 300-349: 6 units, bg over 350: 8 units, 27. lantus 100 unit/ml solution sig: twelve (12) units subcutaneous at bedtime. discharge disposition: extended care facility: nursing and rehab center - discharge diagnosis: primary hypovolemic hypotension secondary chest pain, etiology unknown, likely gi related chronic kidney disease diabetes mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you while you were in the hospital. you were admitted because of your chest pain and low blood pressure after dialysis on wednesday, , and then ultrafiltration on . your blood pressure improved when we hydrated you with fluids. your chest pain was relieved with maalox-lidocaine, which means that your chest pain is likely caused by your gastrointestinal tract. we ran tests, which indicated that the pain was not caused by your heart. the gas pain you had improved with stool softeners and laxatives. please be careful with how much narcotics you take because this can worsen constipation and increase your abdominal pain. . it's important for you to follow-up with your primary care physician and your kidney doctor to review your medications. . please continue taking your home medications, with the following changes: 1. stop taking tobramycin dexamethasone eye ointment 2. stop taking magnesium hydroxide 3. stop taking levemir 4. stop taking aspart 5. start taking humalog 6. start taking glargine 7. start taking maalox for your chest pain 8. start taking ondansetron for your nausea followup instructions: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. diaylsis phone: nephrologist-dr. /w/f **dr. will follow up with you at your next scheduled diaylsis appointment. please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. diaylsis phone: nephrologist-dr. /w/f **dr. will follow up with you at your next scheduled diaylsis appointment. department: center when: wednesday at 9:30 am with: , m.d. building: sc clinical ctr campus: east best parking: garage name: , md department: gastroenterology address: ,ste 8a, , phone: appointment: wednesday 10:30am procedure: hemodialysis diagnoses: end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere esophageal reflux hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia other chest pain personal history of venous thrombosis and embolism kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypovolemia diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled hypotension of hemodialysis borderline personality disorder 

Answer: The patient is high likely exposed to