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: patient recorded as having no known allergies to drugs attending: chief complaint: ams major surgical or invasive procedure: intubated extubated history of present illness: 51m h/o af on coumadin, chf, hl, hyperthyroidism, no known dm found down by fam at 245p. ems took him to , found to be in raf with rate in 130s but also had fsbs of 850 and hyponatremic to 120. wbc 14. trop positive there. taken to , t100, fsgs 800s, in raf rate 100s. intubated at for respiratory protection and given 10 then 30mg dilt, insulin + gtt @ 2/hr, 8mg ativan, 4mg morphine and started on propofol gtt. ct head there negative. here at ed in sinus rhythm with rate 85 bp 188/92. tm while in ed 100. on exam was intubated and sedated on vent. trop was 0.05 in setting of creatinine 1.1 (1.3 at osh). glucose was down to 200s per ems reports but 634 here. tox screens negative. leukocytosis here. got pcxr ett in good placement with possible aspiration vs mfpna. received ceftri 2g at osh and 500 azithro plus 500 flagyl here. also got 10units iv insulin and on 3units/hr gtt. for troponin leak got 325mg asa. blood and urine cultures pending. ekg af 93 na qtc 443 qrs 112 st dep v5-6. no prior. vs prior to transfer: hr93 171/46 100 on ac 550x18 100% fio2 peep 5. . on the floor, intubated sedated, not following commands. past medical history: hl chf hypothyroidism afib on coumadin gout arthritis asthma osa on cpap at home (unknown settings) etoh use (3 drinks nightly) no h/o withdrawal knee, shoulder, and hip replacements left lung resection for unknown reasons (family doesnt know) social history: smoker family history: unknown physical exam: vitals: t: 98.4 ax bp: 138/73 p:99 irreg r: 18 o2:100 on 550x18 100% peep 5 general: obese. intubated, sedated on propofol heent: sclera anicteric, drymm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregularly irregular normal s1 + s2, no murmurs, rubs, gallops, non-displaced pmi abdomen: obese soft, non-tender, non-distended, bowel sounds present, gu: foley ext: warm, well perfused, no edema neuro: perrl, withdraws to painful stimuli bilaterally upper and lower extremities pertinent results: cta chest findings: patient is intubated with the endotracheal tube ending 3.4 cm above the carina. there is no aortic dissection or evidence of pulmonary embolism. the ascending aorta is enlarged measuring up to 5.1 cm in diameter. the main pulmonary artery is also prominent, measuring up to 4.4 cm in diameter. there is moderate cardiomegaly. fat density is noted within the interatrial septum, most likely due to lipomatous hypertrophy. patient is status post left upper lobectomy. suture material is noted at the left hilum. there are dense calcifications also noted at the left lung base along the diaphragm, likely related to prior surgery. there is minimal atelectasis in the remaining left lobe. a 2-mm pulmonary nodule is noted within the right middle lobe. dependent atelectasis is noted posteriorly in the right. there is no mediastinal, hilar, or axillary lymphadenopathy. visualized aspects of the upper abdomen demonstrate diffuse fatty infiltration of the liver. remainder of the visualized upper abdomen is unremarkable. bone windows: no concerning osseous lesions are identified. mild degenerative changes are noted throughout the visualized spine. impression: 1. no pulmonary embolism or aortic dissection. prominent ascending aorta measuring up to 5.1 cm. prominent main pulmonary artery measuring up to 4.4 cm, suggesting pulmonary hypertension. 2. 2-3 mm nodule in right middle lobe for which no follow up is needed if low risk (no underlying malignancy or smoking). if not, recommend follow up ct in 12 months. 3. cardiomegaly. 4. status post left upper lobectomy. 5. diffuse fatty deposition in the liver. . echo the left atrium is mildly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild global left ventricular hypokinesis (lvef = ?40 %). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size is normal. with mild global free wall hypokinesis. the ascending aorta is moderately dilated. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal.trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with mild global hypokinesis c/w diffuse process (toxin, metabolic, tachycardia, etc. - cannot excluded multivessel cad). dilated ascending aorta. . 12:33am blood wbc-14.9* rbc-5.02 hgb-16.4 hct-45.7 mcv-91 mch-32.7* mchc-35.9* rdw-14.5 plt ct-273 12:33am blood neuts-86.7* lymphs-8.3* monos-3.9 eos-0.4 baso-0.6 12:33am blood pt-28.5* ptt-29.9 inr(pt)-2.8* 12:33am blood glucose-634* urean-25* creat-1.1 na-128* k-3.8 cl-85* hco3-27 angap-20 12:33am blood alt-93* ast-93* ck(cpk)-74 alkphos-163* totbili-0.5 12:33am blood ctropnt-0.05* 12:33am blood albumin-4.1 calcium-8.9 phos-4.2 mg-2.0 04:43am blood digoxin-0.4* 12:33am blood tsh-1.9 ..... discharge labs hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:48 7.6 4.73 15.4 44.6 94 32.6* 34.6 14.9 278 . basic coagulation pt ptt plt ct inr(pt) 06:48 278 06:48 16.0* 23.2 1.4* . renal & glucose glucose urean creat na k cl hco3 angap 06:48 171*1 18 0.8 140 3.8 101 28 15 . lipid/cholesterol cholest triglyc hdl chol/hd ldlcalc 06:48 168 312*1 21 8.0 85 brief hospital course: 51yo m with h/o dm and af on coumadin presenting with ams found to have honc and raf admitted to icu for insulin gtt. . # respiratory failure: patient intubated ams to protect airway. cxr revealed widened mediastinum and likely chf although cannot r/o mf pna. ct done and showed lobectomy and rll pneumonia. given concern for cap vs. aspiration pna, treated with ctx/azithro/flagyl. patient's ms improved and was able to be extubated on hd 2. flagyl was d/c's on day of treatment due to small likelihood this was aspiration. completed 6 days of treatment with ctx and azithromycin. the patient will finish a full 7 day course with po levofloxacin following discharge. . # honk / diabetes mellitus: patient has no known h/o dm but fsbs in 800s at osh with neurologic and electrolyte abnormalities consistent with hhs. unclear etiology of this although may be first presentation of his dm2. insulin gtt was started, electrolytes monitored and repleted. patient never developed an anion gap. gtt discontinued on and pt started on insulin sliding scale. hba1c was 11.9% for an estimaged average glucose of 295. discharged on metformin, lantus, and humalog sliding scale with sugars well controlled from 150s - 220s. will have vna for diabetes / finger stick and insulin administration teaching. . # demand ischemia: patient has elevated trop with lateral st changes on ekg and no prior to compare with but in setting of af with rvr so more likely demand than acs. hr controlled with labetalol iv which will also help bring down bp. tte done that did not show any wall motion abnormalities, but did show reduced ef with global hypokinesis. patient should follow-up with cardiology. he is discharged on metoprolol for rate control. . # hyponatremia: hypovolemic hyponatremia likely in setting of hhs however corrected na is 136 so actually likely hyperosmoloar state and only pseudo-hyponatremia. . # atrial fibrillation: presented in sinus rhythm with good rate control. coumadin held initially in case of procedures. restarted on with inr of 2.0. digoxin held given k fluctuation while in hhs. heart rate was increasing so diltiazem was increased to 60mg qid. as patient had tte that showed reduced ef, he was started on a beta blocker instead, and diltiazem was discontinued. digoxin continued to be held as patient was stabilized on regimen. . # hyperthyroidism: unclear when last tsh drawn and could be precipitant of hhs if out of control. tsh normal and levothyroxine continued. . # chronic systolic chf: unclear if diastolic or systolic. though based on echo from likely systolic. patient only on lasix and dig (which could be for af not chf). judicious use of fluids once honk well-treated given patient presented hypo-euvolemic. initially, lasix and zaroxylin held given recent and needing hydration for honk and being down for at least 1 day. this was restarted after the patient was extubated. he was started on ace-i, beta-blocker prior to discharge and should follow up starting ace-i with chem-7 in one week. on outpatient basis, should likely be started on a statin as well. he may also benefit from follow-up echo. . # ams / alcohol withdrawal: patient was agitated night after being extubated, combative and required restratints. these were removed in the morning. he then became very tearful and distressed in the afternoon, which resolved without support. he also discussed paranoid delusions (thought he was being videotaped or in a moviem thought room decoration was changing) and some visual hallucinations. on discharge the patient was no longer on a ciwa scale for greater than 36 hours. . # code status: initially unknown and patient intubated. family came in. patient is dnr but ok to "i". no blood products as patient is a jehovah's witness. medications on admission: warfarin 5mg daily zaroxolyn 5 mg daily allopurinol 300mg daily levothyroixine 0.025mg daily lasix 20mg digoxin 0.125mg daily diltiazem cd 120 daily albuterol 2 putts q6h prn discharge medications: 1. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 2. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 4. metoprolol tartrate 25 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* 5. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metformin 500 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) for 7 days: apply to lower back and change daily. disp:*7 adhesive patch, medicated(s)* refills:*0* 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). tablet, chewable(s) 9. insulin glargine 100 unit/ml solution sig: twenty four (24) units subcutaneous at bedtime. disp:*720 units* refills:*2* 10. humalog 100 unit/ml solution sig: 0-16 units subcutaneous four times a day as needed for high blood sugar: please check fingersticks prior to meals and administer insulin per sliding scale. disp:*1500 units* refills:*2* 11. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 1 days. disp:*1 tablet(s)* refills:*0* 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 13. lasix 20 mg tablet sig: one (1) tablet po twice a day. 14. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 15. metolazone 5 mg tablet sig: one (1) tablet po once a day. 16. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 17. oxycodone 5 mg tablet sig: one (1) tablet po every eight (8) hours for 7 days: do not drive or operate heavy machinery while taking oxycodone. disp:*15 tablet(s)* refills:*0* 18. outpatient lab work chem 7, inr please fax to dr. at 19. glucometer plus strips and lancets please provide patient with glucometer x1, lancets x120, and glucometer strips x120 discharge disposition: home with service facility: bayada nurses inc discharge diagnosis: primary diagnoses: community acquired pneumonia, hyperosmolar hyperglycemic nonketotic coma, alcohol withdrawal . secondary diagnoses: systolic heart failure, atrial fibrillation with rapid ventricular response, alcohol dependence, type ii diabetes mellitus, obstructive sleep apnea, hypothyroidism, hypertension, back pain discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for high blood sugar due to undiagnosed diabetes that was likely worsened by pneumonia. your high blood sugar was treated with iv fluids and insulin. you will need to continue taking lantus insulin at night, and check your sugars four times a day and to take humalog insulin as directed by your sliding scale. you were also started on metformin, a pill which should help control your sugar and in time lessen the amount of insulin you require. your pneumonia was treated with iv antibiotics. you were transitioned to levofloxacin, an antibiotic which you can take by mouth, which you should take tomorrow. your hospital stay was complicated by alcohol withdrawal. you were treated for your withdrawal with valium. by the day of discharge you were no longer showing signs of withdrawal and did not require any valium. you also complained of chronic back pain. you were given tylenol and ibuprofen for your pain. you were also given a lidocaine patch. you should take tylenol and ibuprofen together for your pain, and you can use the lidocaine patch daily. if your pain is too severe to respond, you can try oxycodone for your pain. importantly, you should stop drinking alcohol as you are causing extreme harm to your health and are at danger as well for dangerous withdrawal when you stop drinking suddenly. finally, it is absolutely imperative that you have a primary care physician to closely follow your now chronic medical problems such as atrial fibrillation, heart failure, diabetes, alcohol dependence, and back pain. please follow-up with a primary care physician in the next 7 days for further management of these problems. should also have your blood drawn for lab work in 7 days which your primary care should follow-up. .... the following changes were made to your medications: you should start taking the following medications: metoprolol tartrate, insulin (both lantus (glargine) and humalog), metformin, lidocaine patch, tylenol and oxycodone as needed, a multivitamin, levofloxacin (one dose on day after discharge), lisinopril, baby aspirin. . you should stop taking: digoxin, diltiazem. . you should continue all other prescribed medications. . you should talk to your primary care doctor about starting on a statin and titrating the doses of your metoprolol, lisinopril, metformin, insulin, and diuretics (lasix and zaroxolyn (metolazone)). you should talk to your primary care doctor about long-term management of your chronic back pain. . it was a pleasure taking care of you. followup instructions: please follow up with a primary care physician in the next 7 days! procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more arterial catheterization diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) other chronic pain tobacco use disorder congestive heart failure, unspecified toxic encephalopathy hyposmolality and/or hyponatremia unspecified acquired hypothyroidism gout, unspecified atrial fibrillation asthma, unspecified type, unspecified thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm other and unspecified hyperlipidemia acute respiratory failure chronic systolic heart failure long-term (current) use of anticoagulants backache, unspecified knee joint replacement other and unspecified alcohol dependence, continuous hip joint replacement alcohol withdrawal arthropathy, unspecified, site unspecified diabetes with hyperosmolarity, type ii or unspecified type, uncontrolled shoulder joint replacement 

Answer: The patient is high likely exposed to