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: latex attending: chief complaint: seizure, hyperglycemia major surgical or invasive procedure: central line placement history of present illness: 59yof with h/o dm but not on medications, hypothyroidism, hyperlipidemia coronary artery disease, and hypertension presented to osh with altered mental status and seizure found to have hhs and transferred to for further management. per the patient's daughter over the last few months the patient has lost a lot of weight, not been able to go 5 mins without using the bathroom, and has felt fatigued. she was started on a new thyroid medication in the last few weeks. she was supposed to see the doctor but postponed to today. however, last night she was "not herself" but she said she was fine. this morning her daughter still thought she was altered but the patient insisted that she go to work this afternoon at 2pm. at 6:30 a police officer drove the patient home and reported that she had driven her car into a pole, was confused but had refused to go to the hospital. then the patient went to her room and fell asleep, while her dtr went to get the car (about 1 hour). after this the daughter insisted they go to the hospital. on the car ride she began losing consciousness and as they arrived to the hospital had a seizure. (documented as gtc by osh). received ativan and dilantin. head ct normal. at osh labs notable for glucose in 1400s and na 139. abg 7.19. then reportedly became apneic and was intubated at . given sc insulin and insulin gtt at 6 units /hr. got 4l ns at osh. never hemodynamically unstable in the ed initial vs: t: af, bp labile (80-90) when on propofol. received 2 more l ns. pcxr showed infiltrate rll. patient was given ctx/vanc/flagyl, continue the insulin gtt. na 150 despite the glucose coming down. vs on transfer: t: hr 80 bp 100/54 100% on ac 420x26 fio2100 peep 5. on arrival to floor patient was awake and fighting the tube. she was unable to answer questions. her family was not available to ask historical questions. ros per daughter no fevers, viral symptoms, cough, sick contacts. losing her hair recently and pcp changed her thyroid medication to treat it. past medical history: diabetes mellitus not on medication hypertension "holes in her heart s/p surgery" hypothyroidism hyperlipidemia coronary artery disease social history: lives with her daughter, works as a home health aide. non-smoker, non-drinker. family history: mom with diabetes. physical exam: admission: vs: temp:97 bp:153 /67 hr:99 rr: o2sat 92% on ac 420x16 peep 5 fio2 100 gen: intubated sedated heent: perrl at 2mm, anicteric, mmm, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: crackles at the right base cv: rr, s1 and s2 wnl, no m/r/g cvp 5 abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice neuro: intubated and sedated. pupils 2mm and reactive. when sedation off awake and fighting the tube . discharge: vitals - tm: 100.0 tc:98.8 p:80 (72-97) bp:116/76 (108-118/68-74)rr20 98% ra. general: elderly female appearing comfortable and in no acute distress heent: left trapezius tender and tense, no increased warmpth chest: ctabl no wheezes, no rales, no ronchi cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: overweight, non-distended, bs normoactive, soft, non-tender ext: no edema. rle calf swelling, palpable cord posterior to knee. positive left sided homman's sign. pertinent results: admission labs: labs at : wbc 10.6, hct 46, plt 396 abg: 7.19/61/175/23 on nrb na 139, k 6.2, cl 97, co2 22, gluc 1432, bun 62, cr 1.8 acetone positive alb 4.5 tbili 1.6 ca .1 alt 87, ast 29 . labs at : abg: 7.31 50 328 26 on 500x16, 100, 5 na:154 k:5.0 cl:116 lactate:1.9 . na:150 cl:109 bun:55 gluc:931 agap=18 k:5.4 hco3:23 cr:1.6 ca: 11.1 mg: 3.7 p: 4.2 alt: 39 ap: 88 tbili: 0.5 ast: 31 lip: 124 wbc: 10.9 hgb:15.1 plt:374 hct:46.9 n:84.2 l:10.6 m:4.2 e:0 bas:1.1 . 12:15am blood alt-39 ast-31 alkphos-88 totbili-0.5 10:11pm blood %hba1c-19.4* eag-510* 05:59am blood triglyc-278* hdl-45 chol/hd-3.8 ldlcalc-71 03:48am blood tsh-4.7* . discharge: 06:10am blood wbc-7.8 rbc-3.09* hgb-9.9* hct-29.0* mcv-94 mch-31.9 mchc-34.0 rdw-15.9* plt ct-288 06:10am blood pt-13.4 ptt-26.6 inr(pt)-1.1 06:10am blood glucose-99 urean-7 creat-0.7 na-139 k-4.0 cl-107 hco3-26 angap-10 06:10am blood calcium-8.3* phos-3.5 mg-2.3 . . micro urine culture negative final catheter tip negative final blood culture negative final blood culture negative final urine culture negative final blood culture negative final blood culture negative final blood culture negative final blood culture negative final . imaging: lower ext dopplers findings: waveforms in the common femoral veins are symmetric bilaterally with appropriate response to valsalva maneuvers. in the right lower extremity, the common femoral, proximal and mid superficial femoral veins as well as proximal greater saphenous are all normal with appropriate compressibility, and wall-to-wall flow on color analysis. there is non-compressibility of the distal portion of the superficial femoral vein as well as of the popliteal vein, with absent flow on color doppler analysis, related to deep venous thrombosis in those locations. wall-to-wall flow and compressibility is noted in the posterior tibial and peroneal veins in the right calf. . in the left lower extremity, the common femoral, proximal greater saphenous, superficial femoral and popliteal veins are normal with appropriate compressibility, wall-to-wall flow on color analysis and response to waveform augmentation. wall-to-wall flow is also seen in the posterior tibial and peroneal veins in the left calf. . impression: right popliteal and distal superficial femoral vein thrombosis. . cxr moderate left pleural effusion has increased and left lower lobe atelectasis or consolidation has improved. right lung is grossly clear. the heart is severely enlarged and dilated pulmonary arteries are an indication of pulmonary arterial hypertension. right jugular line ends in the svc. no pneumothorax. . echo the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. . 6:12 am nasogastric tube has been advanced into the stomach which is somewhat less distended with gas, and out of view. left lower lobe atelectasis is worsened, right atelectasis improved. upper lungs clear. borderline cardiomegaly stable. probable pulmonary hypertension. upper lungs clear. right jugular line ends in the mid to low svc. no pneumothorax. . : left pleural effusion, likely pulm arterial hypertension . ct head from : diffuse cerbral atrophy appropriate for patient's age, right nasal ganglia calicifactions, no cerebral ischemia, no ich, no mass. . ct c spine: no acute fracture or malalignment. degenerative changes c5-c7. brief hospital course: 59 yo female with h/o dm admitted with hhs and seizure. . # hyper osmolar hyperglucemic state: the patient has a history of an elevated bs in clinic a year ago which per her daughter resolved without treatment. she had not been on medications for diabetes. per her daughter she had symptoms of polyuria and weight loss for several months prior to presentation suggestive of hyperglycemia. prior to admission at , patient was intubated for airway protection. she was started on an insulin gtt in the ed which was uptitrated according to protocol. while in the icu, she was promptly extubated and treated with insulin drip and ivns. her hypokalemia and fluid deficit where repleted with frequent monitoring. she was started on a d5 gtt once her bs became <200 to maintain bs 200-300. after a two admission to the icu, patient was called out to the general medical floor. . regarding cause of hhs, most likely this was a slowly developing hyperglycemia in the setting of uncontrolled diabetes. no underlying infection or acute insult was detected. blood and urine cultures were sent and are pending. cxr did show an infiltrate which was consitent with aspiration, and per her daughter she had no clinical symptoms pointing towards pna. # diabetes mellitus: ha1c is 19. after admission to general medical floor from icu, she was stabalized on an insulin regimen consisting of glargine at bedtime and prandial humalog with correction factor. she was given diabetes teaching with the staff hatian creole interpreter and was able to draw up insulin and administer it without difficulty. she is believed to have flatbush diabetes and will need to be on insulin in the acute phase but may be able to transition to oral agents after two months. it is recommended that c-peptide be checked in two months time to determine native insulin production and guide decision to begin oral hypoglycemics. she was discharged with a plan for outpatient follow up with the clinic. . # respiratory: patient was intubated secondary to change in mental status due to her seizure for airway protection. on cxr has evidence of aspiration with right hilar fluffy infiltrate, however per her daughter she had no clinical history of pneumonia prior to her acute event. she remained intubated overnight and the morning of her sedation was weaned and she was successfully extubated. she was initially treated with vanc, ceftriaxone, and flagyl for a persumed aspiration pna and these were continued in the setting of her transient hypotension. however following extubation, she was without a leukocytosis or fever and was normotensive once her sedation was weaned so antibiotics were stopped after extubation on . . # deep vein thrombosis: beginning hd 4, patient had recurrent low grade fevers. infectious work up including cxr, ua and urine culture, blood culture, central line tip culture were all negative. lower extremity doplers showed right lower extremity dvt and patient was started on enoxaparin and warfarin. deep vein thrombosis was explained to patient using the staff hatian creole interpreter and she stated understanding of dvt, risk of pulmonary embolism and importance of anticoagulation and frequent inr checks. she was taught how to administer enoxaparin. she will need to continue enoxaparin until inr is , and will need to continue warfarin x 3 months, final day . she was discharged with a plan for outpatient follow up in three days and inr checks. . # hypernatremia: likely in the setting of dehydration from severe hyperglycemia and corrected is actually higher (164). be reason for seizure as well. initially worsened from admission due to decrease in serum glucose. hypernatremia was corrected slowly in in the icu with d5 1/2ns and d5 to decrease the risk of cerebral edema. on transfer to the general medical floor, her sodium had corrected. . # seizure: likely from hypernatremia/hyperosmolar state. no reoccurance of seizure in the icu or for remainder of hospital stay. . # acute kidney injury: unknown baseline. patient with cr of 1.6 on admission. trended down to 1.0 with volume resuscitation. likely secondary to prerenal/volume depleption. . # hypercalcemia: mild and in setting of acute illness and hyperosmolar state creating intravascular free water depletion. normalized with volume resuscitation. . # transient hypotension: thought to be related to sedation with propofol. resolved with weaning sedation and extubation. . # hypothyroidism: dose is confirmed with pcp as new dose. . comm: with patient and family code: full medications on admission: lasix 20 mg po daily fosinopril 40 mg po daily levothyroxine 0.1 mg po daily lovastatin 20 mg po daily flucinonide cream 0.05% discharge medications: 1. enoxaparin 100 mg/ml syringe sig: ninety (90) mg subcutaneous q12h (every 12 hours) for 7 days. disp:*1260 mg* refills:*0* 2. furosemide 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. lovastatin 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 5. coumadin 2.5 mg tablet sig: two (2) tablet po once a day: your doctor may adjust this based on your blood tests. disp:*60 tablet(s)* refills:*0* 6. insulin glargine 100 unit/ml solution sig: thirty five (35) units subcutaneous at bedtime. disp:*1 bottle* refills:*0* 7. humalog 100 unit/ml solution sig: per instructions below units subcutaneous three times a day: 14 units with breakfast 12 units with lunch 12 units with dinner . disp:*1 bottle* refills:*0* 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 9. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 10. freestyle lite meter kit sig: one (1) miscellaneous four times a day. disp:*1 kit* refills:*2* 11. freestyle lite strips strip sig: one (1) strip miscellaneous four times a day for 14 days. disp:*56 strips* refills:*0* 12. syringe (disposable) syringe sig: 0.5 cc miscellaneous five times a day: " 31 guage. disp:*120 syringes* refills:*0* 13. lancets misc sig: one (1) lancet miscellaneous four times a day. disp:*120 lancets* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diabetes mellitus . secondary hyperosmolar hyperglycemic state seizure deep vein thrombosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms , it was a pleasure taking care of you in your hospital stay at . as you know, you had very high blood sugars, confusion and seizures. you were admitted to the intensive care unit where you were briefly on a ventilator to help you breath. we treated your high sugars with insulin and will be giving you insulin prescriptions to help you control your sugars at home. . you also developed a blood clot in your leg, a deep vein thrombosis. you will need to thin your blood with injections of lovenox and pills of coumadin. you will need to have your coumadin level checked frequently by your primary care provider. continue to take both of these medications until your primary care privider tells you to stop. . new medications coumadin 10mg by mouth daily for blood thinning lovenox 90mg subcutenously twice a day for blood thinning humalog insulin 12 units with lunch and dinner humalog insulin 14 units with breakfast glargine insulin 35 units at bedtime followup instructions: please make an appointment to . name: , c address: , , phone: appointment: monday 2pm. **you can walk in to see your doctor between the hours of 2pm-6pm.** please bring in your discharge summary to this appointment for dr. to review. thanks. . name: , md location: diabetes center address: one place, , phone: appointment: tuesday at 9am please call masshealth insurance as soon as possible to choose your plan. their number is . if you do not fix your insurance, this appointment will be self pay. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours arterial catheterization diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism other chronic pulmonary heart diseases other convulsions systolic heart failure, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin hyperosmolality and/or hypernatremia intravenous anesthetics causing adverse effects in therapeutic use hypercalcemia acute venous embolism and thrombosis of deep vessels of distal lower extremity diabetes with hyperosmolarity, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to