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: nsaids / sulfa (sulfonamide antibiotics) attending: chief complaint: transfer from neurosurg to micu for acute renal failure major surgical or invasive procedure: ivc filter placement central line placement arterial line placement hemodialysis intubation/mechanical ventilation history of present illness: 85m with prior dvt, htn and ckd was admitted to nebh with decreased appetite and le swelling. found to have extensive dvt and acute on chronic rf. was started on heparin gtt and yesterday was noted to have a right facial droop and increased dysarthria, r-sided weakness and somnolence. he developed what appeared to be a r-sided seizure and then a grand-mal seizure in the ct scanner at the osh. he was intubated for airway protection and transferred to to the neurosurgery service. he was noted to be hypotensive after intubation (without sedation) prior to transfer and was started on neo. an aline was placed also prior to transfer. . this morning, the neurosurgery attending asked that the micu take over his care given the complexity of his medical problems. . on eval, he was intubated and sedated. does not follow commands. not on sedation although received 2 mg of iv ativan within the past 2 hours for possible seizure. . per his son who is at his bedside, he was doing well until about 2 months ago at which point they noticed a 15 pound weight loss and hematuria. bladder cancer was discovered and he had a cystoscopic removal of tumor. 2 weeks ago, his son noted that he was increasingly tired w/ decreased appetite and le swelling. he fell and hit his head about 1 week ago but his son noticed only a small cut and so did not have him evaluated. over the week prior to admission, he became unable to walk and needed a wheelchair to get around. past medical history: htn thoracic and abdominal aortic aneurysm h/o transitional cell bladder cancer ckd h/o lumbar laminectomy tertiary hyperparathyroidism bph dvt in the past, s/p ivc filter placement bilateral cataracts s/p removal glaucoma s/p l tkr ? unclear per records pvd ? fem/ bipass social history: was living independently prior to 2 weeks ago. physical exam: admission exam: general: intubated and sedated, bites down on ett heent: sclera anicteric, pinpoit pupils, oropharynx clear 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 abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: cool feet bilaterally w/ eschar on r great toe, lle swelling w/ +2 edema, not able to palpate pedal pulses; doplerable lle dp/pt and r dp. pertinent results: admission labs: 06:58pm blood wbc-17.1* rbc-2.73* hgb-8.5* hct-24.1* mcv-88 mch-31.0 mchc-35.1* rdw-16.9* plt ct-175 06:58pm blood neuts-88.8* lymphs-6.7* monos-4.3 eos-0.1 baso-0.1 06:58pm blood pt-13.7* ptt-27.6 inr(pt)-1.2* 06:58pm blood glucose-162* urean-51* creat-3.6* na-141 k-4.2 cl-107 hco3-21* angap-17 06:58pm blood alt-32 ast-45* ck(cpk)-778* alkphos-46 amylase-44 totbili-1.1 06:58pm blood ck-mb-5 ctropnt-0.12* 03:38am blood ck-mb-6 ctropnt-0.14* 01:23pm blood ck-mb-7 ctropnt-0.15* 06:58pm blood albumin-2.6* calcium-7.5* phos-4.7* mg-1.9 06:58pm blood free t4-1.1 06:58pm blood tsh-1.5 06:58pm blood phenyto-14.7 07:08pm blood type-art po2-306* pco2-28* ph-7.48* caltco2-21 base xs-0 07:08pm blood lactate-1.8 . radiology studies: . ct head on admission: findings: a mixed but predominantly hyperdense collection overlies the entire left cerebral hemisphere, measuring up to 19 mm in greatest transverse dimension, and extending along the left tentorium. it is consistent with a predominantly acute subdural hematoma. this exerts mass effect upon the left hemisphere, predominantly in the frontal and temporal lobes, with effacement of the underlying cerebral sulci and mild left frontal edema. there is a mild rightward shift of the anterior falx, septum pellucidum and third ventricle. there is mild mass effect upon the left lateral ventricle. no intraventricular hemorrhagic extension and no parenchymal hemorrhage is identified. prominence of the cerebral sulci is compatible with age-related involutional change. periventricular regions of hypodensity are compatible with chronic microvascular ischemic change. no fracture is identified. the paranasal sinuses and mastoid air cells are well aerated. the orbits are unremarkable. endotracheal and nasogastric tubes are noted. impression: large acute subdural hematoma along the convexity and tentorium, with mass effect as described above. . ct head on for follow up: findings: an evolving subdural hematoma along the left cerebral convexity again likely extends along the left tentorium cerebelli. minimal, 1 mm, rightward midline shift is unchanged. ventricular and sulcal caliber is unchanged and no new intracranial hemorrhage is identified. moderate-to-severe periventricular white matter hypodensity is consistent with chronic small vessel ischemic changes. atherosclerotic calcifications involve the cavernous carotids and intracranial vertebral arteries bilaterally. the imaged portions of the paranasal sinuses appear well aerated. impression: evolving left cerebral convexity subdural hematoma with unchanged minimal mass effect, stable compared to the ct from . . mri head: findings: areas of slow flow and restricted diffusion are seen in the right posterior parietal periatrial region with high signal on diffusion images and low signal on adc map indicative of acute infarcts. small acute infarcts are also seen in right parietal and left frontal lobes. there is subacute subdural hematoma identified extending from frontal to occipital region on the left with a maximum width of approximately 1.5 cm to 2 cm at the convexity with indentation on the sulci. increased signal along the sulci may indicate small amount of subarachnoid hemorrhage or stasis of the csf secondary to subdural. small amount of subdural collection is also seen along the left side of the tentorium. there is no midline shift seen. moderate to severe brain atrophy and moderate changes of small vessel disease are identified. there is no midline shift. sagittal t2 images were obtained to evaluate the brainstem, but are limited by motion. changes of cervical spondylosis are visualized, which are further evaluated with cervical spine mri. bilateral basal ganglia lacunes are seen. impression: 1. small areas of restricted diffusion in the left frontal lobe, right parietal lobe, and left periatrial region suggestive of embolic infarcts. 2. left-sided subdural hematoma extending from frontal to occipital region with obliteration of adjacent sulci. no midline shift. brain atrophy and small vessel disease. . mri c-spine impression: 1. limited study due to motion. multilevel degenerative change is seen. 2. moderate spinal stenosis at c4-5 and mild-to-moderate spinal stenosis at c5-6 and c6-7 with extrinsic indentation on the spinal cord. 3. postoperative changes with posterior bony bar at c3-4 slightly indenting the spinal cord. atrophic changes in the spinal cord at c3-4 level. . echos: : the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the basal inferior and inferolateral walls. the remaining segments contract normally (lvef = 50 %). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the descending thoracic aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal left ventricular cavity size with mild regional systolic dysfunction c/w cad (pda distribution). dilated ascending and descending thoracic aorta. mild pulmonary artery systolic hypertension. . : the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the inferior and inferolateral walls. the remaining segments contract normally (lvef = 50 %). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , a prominent left pleural effusion is now identified and the estimated pulmonary artery systolic pressure is lower. left ventricular wall motion is similar. . lower extremity cath: comments: 1. access via lfa via 4f catheter. 2. imaging of the distal aorta with a omniflush catheter at l1 revealed mild aortic disease with no renal artery stenosis. the iliacs were very tortuous on both sides but without flow limiting lesions. the cfa's were without lesions. 3. imaging of the right leg with a slip cath in the right sfa revealed a mid sfa 10cm occlusion. there was a high grade popliteal lesion and single vessel run off to the foot via a peroneal. there was only very faint filling of plantars and dp. 4. referral to vascular surgery for right leg bka. final diagnosis: 1. right sfa occlusion with severe infra-popliteal disease. . renal us: impression: probably no hydronephrosis. . ct abdomen and pelvis follow up: findings 100 cc of contrast was administered through g-tube. there is no contrast extravasation. extensive pneumoperitoneum is again noted. however, this is unchanged from the prior examination from the previous day. there is bilateral pleural effusion, small in quantity, not significantly changed from the prior study. the unenhanced liver and spleen appear unremarkable. there is bilateral hydronephrosis and mild hydroureter. this is likely on the basis of the significant wall thickening seen in the urinary bladder. aneurysmal abdominal aorta at the diaphragmatic crura is unchanged from prior study, with atherosclerotic changes. the gallbladder appears dilated, though unchanged from the prior study. again noted is prominence of the left psoas muscle, with an area of hypodensity, which may represent fluid collection, however, infection cannot be excluded. there is no evidence of bowel dilatation. ivc filter is again noted. there are degenerative endplate changes in the thoracolumbar spine. impression: 1. no evidence for g-tube extravasation. 2. no interval change in enlargement of the left psoas muscle with hypodense collection in the left flank. while this may represent old hematoma, a loculated infected collection cannot be excluded and intravenous contrast would be necessary for additional evaluation. 3. again noted mild bilateral hydronephrosis, which is likely secondary to significant bladder wall thickening. 4. unchanged pneumoperitoneum. . ct chest: impression: dilated ascending aorta and thoracoabdominal junction. bilateral psoas hematoma, much larger on the left, extending in the retroperitoneum. . labs on discharge: chms added 2253 141 / 107 / 51 162 agap=17 ---------------- 4.2 / 21 / 3.6 wbc 9.4, hct 28.5, plt 249 all have been stable over the last several days estgfr: 16/20 (click for details) ck: 778 mb: 5 trop-t: 0.12 comments: ctropnt: called ,303am, ctropnt: ctropnt > 0.10 ng/ml suggests acute mi ca: 7.5 mg: 1.9 p: 4.7 alt: 32 ap: 46 tbili: 1.1 alb: 2.6 ast: 45 ldh: dbili: tprot: : 44 lip: 13 serum asa, etoh, acetmnphn, benzo, barb, tricyc negative comments: positive tricyclic results represent potentially toxic levels;therapeutic tricyclic levels will typically have negative results tsh:1.5 free-t4:1.1 phenytoin: 14.7 pt: 13.7 ptt: 27.6 inr: 1.2 fibrinogen: 351 . of note in microbiology, pt only grew albicans in urine, otherwise all cultures were negative without any obvious organism. brief hospital course: 85 year old gentleman with cri, htn, bladder ca and known r transferred from nebh with subdural hematoma, seizures, and new acute on chronic renal failure requiring dialysis. he was transfered to our neurosurgical service then micu for evaluation of altered mental status and sepsis. # altered mental status: ams began with the development of a sdh after treatment of extensive lle dvt with a heparin gtt. the patient was transfered to the micu on . neurosurgery was the initial primary team (then consulting) and based on family discussions and repeat head imaging no intervention was performed. his neurologic status did improve over time, but persistent deficits lead to subsequent neurologic consultation. the following problems were addressed by the neurology team: for his encephalopathy: toxic-metabolic work up identified the following possible etiologies: yeast uti, pna, r le necrosis, l dvt, esrd on hd. his sedating medications were limited. a repeat routine eeg demonstrated no evidence of subclinical sz activity. mri of the brain, however, demonstrated small areas of restricted diffusion in the left frontal love, right parietal love, and left periatal region suggestive of embolic infarcts; improving sdh. for his strokes: mri of the brain demonstrated actute embolic infarcts. a subsequent tte on demonstrated regional left ventricular systolic dysfunction consistent with coronary artery disease. a left atrial/ thrombus cannot be excluded by tte. if clinically indicated, a tee would better assess for this possibility. no significant change from prior. carotid ultrasound noted: less than 40% stenosis in the right and left internal carotid arteries. mra was held due to concern for acute on chronic renal disease. the patient was placed on asa to treat the embolic strokes after consultation with neurosurgery. for his quadraparesis: mri of the c-spine: multilevel degenerative change is seen, with moderate spinal stenosis at c4-5 and mild-to-moderate spinal stenosis at c5-6 and c6-7 with extrinsic indentation on the spinal cord, and postoperative changes with posterior bony bar at c3-4 slightly indenting the spinal cord. atrophic changes in the spinal cord at c3-4 level. the patient was transferred to the micu minimally responsive to stimuli on intermittent ativan. he was intubated for airway protection and maintained on pressure support with minimal requirements. his altered mental status was attributed to a combination of new subdural hematoma, which remained stable throughout admission, and resulting seizure activity. on transfer he is responsive to questions with the appropriateness of his garbled answers uncertain. as treatment for the seizures, he was started on keppra and should be continued on this until neurology follow up is arranged. the dose is keppra 500 mg . #. subdural hematoma: after discovery of an extensive dvt of the lle at an osh, the patient was started on a heparin gtt. he subsequently developed right facial droop and increased dysarthria, r-sided weakness and somnolence. he developed what appeared to be a r-sided seizure and then a grand-mal seizure in the ct scanner at the osh. he was intubated for airway protection and transferred to to the neurosurgery service. he was noted to be hypotensive after intubation (without sedation) prior to transfer and was started on neo. heparin was stopped due to head bleed and ivc filter placed. the patient developed a subdural hematoma at the outside hospital presumed secondary to heparin therapy for a dvt. neurosurgery was the initial primary team (then consulting) and based on family discussions and repeat head imaging no intervention was performed. the hematomas were stable on transfer. see below for seizure treatment related to hematoma. . # seizures: the patient developed right sided seizures likely due to his subdural hematoma as confirmed by eeg and neuro consult. the patient was started on ativan, dilantin, and keppra for seizure control. he will be tapered off of dilantin, transitioned to keppra and the ativan held. . # acute on chronic renal failure: acute on chronic kidney failure likely due to contrast induced nephropathy, despite pretreatment with ivf and bicarb. the patient was admitted with temporary hd line in place after 3 days of hd. he was seen by our renal service and dialyzed once through the temporary line with no further indication for dialysis at the time of transfer. the patient developed a fever of unknown origin, and the temperary hd line was pulled due to concern that it would be seeded by infection. he subsequently developed fluid overload, resistent to medical therapy. nephrology then saw him and placed a permanent hd line, and received regular hd. he develops moderated hypotension during hd but was otherwise asymptomatic. the plan is to continue monday and thursday dialysis indefinitely for now. the renal team will directly contact the receiving rehab facility about dialysis information. . # pneumonia: gram suggestive of infection treated with 7 days of vanc/zosyn followed by unasyn with a resolution of white count and no fevers early in the admission. he did have another infection of unclear source which resulted in sepsis and a second transfer to the micu. see below for details of that infection. . # right toe eschar-unable to palpate, + doppler pulses and concern is for arterial insufficiency. vascular consulted-follow recs suggested nitropaste only, no intervention given bleed and contraindication for heparin. due to intermittant hypotension, the nitropaste was discontinued. he went for catheterization, which demonstrated severe, diffuse disease, not amenable to stenting. due to prior sdh, patient was not a candidate for anticoagulation. prelim report on us showed sfa occlusion with reconstitution distal to popliteal. . #. dvt: the patient was found to have extensive dvt and acute on chronic rf. was started on heparin gtt and subsequently developed a sdh. the heparin was stopped and an ivc filter was placed in . he does not have signs of pe with good oxygenation on room air. . # hematuria: insetting of change of and care. the patient also has a history of bladder cancer; urology saw patient earlier in admission. several u/as were positive for yeast infection. the patient had a prolonged course of oral fluconazole and topical miconazole. the yeast infection cleared on subsequent u/a. but per urology recs, he is to complete a 14 day course of fluconazole. the end date of fluconazole is 11 days from day of discharge on . he should not have his foley changed once at rehab as it was placed with cystoscopy and is a difficult change. he should follow up with urology in 2 weeks after his fluconazole is completed for reevaluation of need for foley. in setting of arf, he does still make small amounts of urine. . # inability to swollow: possibly multifactorial with left sided sdh and acute embolic areas of infarction, in addition to severe cervical spinal stenosis. speach and swallow evaluation occurred on more than one occasion, and he was unable to protect his airway, and did not have a gag reflex. after a significant amount of time with an ng tube, and multiple conversations with the son, her received a g-tube. he is receiving tube feeds and reached his goal rate. . # hypotension developed within two days of g-tube placement and in the setting of penile instrumentation. etiology could be from a number of cuases including bleeding in the setting of his recent g-tube placement, hypovolemia, perhaps increased vagal tone from bladder distention, sepsis from gangrenous foot, and acs. a ct of his abdomen demonstrated a fluid collection that was not consistent with blood by , but could not differentiate between sterile fluid collection or an abscess without contrast. the patient received fluid boluses, narcan to reverse the potential effects of the 1mg of i.v. morphine the patient received. in addition, the patient had blood and urine cultures. the urine culture wa positive for bacteria and >50 wbcs, > 50 rbcs. the patient remained persistently hypotensive despite ivf and was transferred to the micu for concern for urosepsis. see below for micu course. . # anemia: hct 25.5 in setting of hemodilution and hematuria-no further hematuria overnight after foley replaced by urology. iron studies were obtained and were consistent with anemia of chronic disease. the hct remained stable. . # thrombocytopenia: resolved. _____________________________________________ micu admission : patient was transferred to micu on for hypotension in the setting of concern for sepsis with a possible complication of the g-tube placement. imaging did not show problems with the g tube placement and patient became afebrile and resolved leukocytosis on vanc/zosyn/fluconazole. surgery followed and determined that the g tube was safe to use. pressures were map>60 and sbp in 90s, higher than pressures on admission. pressure throughout the course of hospitalization have not been greater than sbp 110. . # sepsis - his hypotension that resulted in transfer to the micu was likely urosepsis, although no organism was ever grown in culture. other sources could have been the intraabdominal fluid collection, although surgery consulted and did not think it was an infection. he responded to a course of vanco and zosyn and should complete a two week course of the antibiotics. the end date is . he had a midline placed for abx administration. he recovered quickly without any need for pressure support. he was not dialyzed during this time because of his hypotension, but has been dialyzed the last two days prior to discharge and was run even. he maintained his bps during this time. . # pneumoperitoneum on ct scan - during imaging while working up his hypotension, ct revealed pneumoperitoneum around the g tube placement. he had a benign abdomen exam and it was not thought to be cause of his hypotension. his tube feeds were initially held, but with surgery following along were restarted several days prior to discharge. he quickly reached goal and did not have high residuals. . # svt - the day prior to discharge, the patient developed transient episodes of svt with rates of 140. the episodes last approximately 1-20 minutes and were asymptomatic to the patient. he maintained a normal blood pressure during these episodes. most of the episodes broke with vagal manuevers or with a spontaneous pvc. we started diltiazem for rate control at a very low dose as to not drop his blood pressures. he tolerated the diltiazem well and should be continued on it. . in summary: 85 y/o m who presented after anticoagulated dvt resulted in sdh. also found to have old strokes, now with resultant quadraparesis. had seizures that were treated with keppra. also initially had a pneumonia, s/p treatment. while receiving imaging during workup of these above issues developed acute on chronic renal failure and started on hd, now due for monday and thursday dialysis. had workup of ischemic feet, showed diseased vasculature, but no intervention done. no infection of necrotic toes. was recovering well but after g tube placement had hypotension likely from sepsis of unclear etiology, although urine most likely source. has known yeast infection in bladder; urology following and has permanent foley cath in. is being treated with vanco and zosyn and fluconazole for sepsis. had svts treated with diltiazem. . so, once at rehab, he should continue his antibiotic course of vanco, zosyn and fluconazole. he can start pt/ot. he should follow up with neuro, urology and his pcp. medications on admission: oxycodone calcitrol prilosec mentax avocat flomax timoptic travatan dyazide vitamin d vitamin b12 . on transfer: lorazepam 2 mg iv once duration: 1 doses order date: @ iv access: temporary central access (icu) location: left subclavian, date inserted: order date: @ 2124 lorazepam 1-5 mg iv q4h seizure activity hold if oversedated order date: @ 0820 1000 ml ns continuous at 80 ml/hr order date: @ magnesium sulfate 2 gm iv once duration: 1 doses order date: @ 0428 1000 ml ns bolus 1000 ml over 60 mins order date: @ 2250 norepinephrine 0.03-0.25 mcg/kg/min iv drip titrate to sbp > 100mmhg order date: @ 500 ml ns bolus 500 ml over 30 mins order date: @ 2149 pantoprazole 40 mg iv q24h order date: @ 500 ml ns bolus 500 ml over 30 mins order date: @ 2149 phenytoin 100 mg iv q8h hold am dose until trough level back. order date: @ 2250 acetaminophen 650 mg pr q4h:prn fever or pain order date: @ piperacillin-tazobactam na 2.25 g iv once duration: 1 doses *awaiting id approval* id approval is required for this order. order date: @ 0058 8. calcium gluconate 2 gm / 100 ml d5w iv once duration: 1 doses order date: @ 0428 pneumococcal vac polyvalent 0.5 ml im asdir order date: @ chlorhexidine gluconate 0.12% oral rinse 15 ml oral use only if patient is on mechanical ventilation. order date: @ sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. order date: @ influenza virus vaccine 0.5 ml im asdir follow influenza protocol document administration in poe order date: @ sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. order date: @ 2124 insulin sc (per insulin flowsheet) sliding scale order date: @ 22. vancomycin 1000 mg iv once duration: 1 doses order date: @ 0058 discharge medications: 1. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 2. timolol maleate 0.5 % drops : one (1) drop ophthalmic (2 times a day). 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical qd (): apply to mid back. 4. heparin (porcine) 5,000 unit/ml solution : one (1) injection (2 times a day). 5. calcium carbonate 1,250 mg/5 ml(500 mg) suspension : one (1) po tid (3 times a day). 6. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. 7. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 8. aspirin 325 mg tablet : one (1) tablet po daily (daily). 9. acetylcysteine 20 % (200 mg/ml) solution : one (1) ml miscellaneous q6h (every 6 hours) as needed for cough. 10. simvastatin 40 mg tablet : two (2) tablet po daily (daily). 11. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 13. levetiracetam 100 mg/ml solution : five hundred (500) mg po bid (2 times a day). 14. fluconazole 200 mg tablet : one (1) tablet po q48h (every 48 hours) for 11 days: monitor for interaction with statin. watch for ck elevation or rhabdo. . 15. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) gram intravenous hd protocol (hd protochol): through . . 16. piperacillin-tazobactam 2.25 gram recon soln : one (1) intravenous twice a day: through . 17. insulin lispro 100 unit/ml solution : per sliding scale subcutaneous asdir (as directed): please see sliding scale. 18. epoetin alfa 10,000 unit/ml solution : at hemodialysis injection asdir (as directed). 19. verapamil 40 mg tablet : one (1) tablet po q12h (every 12 hours). discharge disposition: extended care facility: & rehab center - discharge diagnosis: -deep venous thrombosis -subdural hemorrhage -seizure disorder -end stage renal disease on hemodialysis -svt treated with vagal maneuvers discharge condition: vital signs were stable, sbp occassionally drops to 80s but pt is without change in mental status. patient with g-tube in place. patient is communicative with non-verbal signs. afebrile. completing course of antibiotics. discharge instructions: you were admitted initially at - with decreased appetite and leg swelling. you were found to have extensive dvt and acute on chronic renal failure. you were later noted to have right-sided weakness and somnolence, developed what appeared to be a right-sided seizure and then a grand-mal seizure. you were intubated for airway protection and transferred to . here we treated you for your seizures. we found that they were likley caused by a large subdural hematoma in your brain. you also developed renal failure and needed to start hemodialysis. he placed a gtube in your stomach to feed you. we also needed to treat you for a severe infection that caused your blood pressure to get low. you were on antibiotics and improved. you will now continue to recover at rehabilitation, complete your course of antibiotics, and work on your strength. please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, or any other symptoms that you are concerned about. followup instructions: please call to make an appointment with dr. - urologist for follow-up 2 weeks after discharge. please call to make and appointment with dr. (neurology) for follow-up for 4-6 weeks after discharge. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung interruption of the vena cava hemodialysis arteriography of femoral and other lower extremity arteries venous catheterization for renal dialysis percutaneous [endoscopic] gastrostomy [peg] arterial catheterization diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease subendocardial infarction, initial episode of care acute kidney failure, unspecified unspecified septicemia candidiasis of other urogenital sites other convulsions sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure hypotension, unspecified personal history of malignant neoplasm of bladder anticoagulants causing adverse effects in therapeutic use atherosclerosis of native arteries of the extremities with gangrene subdural hemorrhage aphasia spinal stenosis in cervical region iatrogenic cerebrovascular infarction or hemorrhage paroxysmal supraventricular tachycardia nutritional marasmus acute venous embolism and thrombosis of unspecified deep vessels of lower extremity chronic total occlusion of artery of the extremities late effects of cerebrovascular disease, other paralytic syndrome, bilateral other hyperparathyroidism dysphagia, unspecified other quadriplegia 

Answer: The patient is high likely exposed to