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: history of present illness: this is an 89-year-old male with history of hypertension, diabetes mellitus, end stage renal disease on hemodialysis who presented to an outside hospital with hypoglycemia. apparently, on the morning of presentation he had a reported glucose of 10, though did not have the typical symptoms of hypoglycemia such as diaphoresis. family members reported decreased p.o. at that time. he went to the dialysis as scheduled, however post dialysis he had six episodes of emesis, non-bloody containing food material. his fingersticks at this point had improved, however his blood pressure was found to be low with a systolic between 90 and 100 with his baseline being about 150 to 160. his fingerstick at that point was in the 700s. he therefore received 10 units of regular insulin three times and then started on insulin drip. at that point, he also had an anion gap of 24 and was believed in dka. his ekg showed new st depressions in leads v3 through v6. he was therefore heparinized and started on aspirin. the patient, himself, denied any chest pain, shortness of breath, diaphoresis, fevers, abdominal pain, polydipsia. he makes minimal urine at baseline. he was transferred to the medical intensive care unit because lack of icu beds at the outside hospital. past medical history: 1. diabetes mellitus. 2. end stage renal disease on dialysis. 3. hypertension. 4. polycythemia . 5. nephrolithiasis. 6. status post transurethral resection of prostate. medications upon transfer: 1. adalat 60 b.i.d. 2. phos-lo two tabs b.i.d. 3. nephrocaps one q. day. 4. aspirin 81 p.o. q.d. 5. colace 100 b.i.d. 6. tylenol #3 as needed. 7. insulin 75/25 30 units in the morning and 10 units in the evening. social history: he is widowed. functioning relatively independently. he is a pastor at a local church and very active socially. physical examination: temperature 96.4 f, blood pressure 101/42, heart rate 100, respiratory rate 16, saturating 100% on nonrebreather. in general awake, alert and appropriate in no acute distress. head, eyes, ears, nose and throat: pupils equal and reactive to light. oropharynx clear. neck: no jugular venous distention. chest: clear to auscultation bilaterally. cardiovascular: tachycardia, but regular, s1, s2 with no murmurs, rubs, or gallops. abdomen is soft, nontender, nondistended with normoactive bowel sounds. extremities reveal no cyanosis, clubbing or edema. neurological exam: he is grossly nonfocal. laboratory data on admission: include white count of 20.2, hematocrit 39, platelets 356. sodium 131, potassium 3.8, chloride 89, bicarbonate 18, bun 31, creatinine 3.3, glucose 764. his lfts were unremarkable. he has an albumin of 2.9, positive acetones and inr of 1.2. hospital course: 1. endocrine: upon initial presentation, the patient was believed to be in dka. this is evident by his anion gap acidosis, ketones in blood and urine as well as extremely elevated glucose. he was started on insulin drip and aggressive hydration which lead to quick resolution of his symptoms. a consultation with the service was obtained and the impression was that this most likely is not true dka. there thoughts were that he probably had hyperglycemia as well as concomitantly occurring metabolic acidosis which could have been out of starvation or other metabolic processes. he had no further episodes of hypoglycemia and only occasional episodes of glucose between 300 and 400. he responded very well to 14 units of humalog q. two hours until blood pressure was normalized. in the hospital he was left on nph insulin 20 units in the morning and 8 units at night with very good glucose control, however he did occasionally require encouraging intakes of p.o. as his sugars were several times in the 60s to 80s. 2. cardiovascular: during his micu stay, the patient had an episode of several hypotension with blood pressure about 70/palp. a set of cardiac enzymes at this point revealed a troponin of 50 and the patient was taken for catheterization to the cardiac lab. the catheterization there revealed a stenotic lesion in the lda about 90% which was stented. it also revealed an rca lesion of 70 to 80% which was nothing to intervene upon on. a following bedside echo following the mi revealed an ejection fraction of about 20%. a consultation with the heart failure service was obtained and their recommendations included continuing beta blocker and ace inhibitor as started by the patient as well as aspirin and plavix. the discussion was initiated about the possible options given the rca lesion. it was felt that at this point, given the patient's overall condition, it would be best not to intervene upon those lesions. there are several options in the future such as doing a stress test to see whether the patient has symptomatic pain from the defects versus purely medical management versus cardiac catheterization in the future if the patient improves symptomatically. we decided to obtain on the day of discharge, another cardiac echocardiogram now that his cardiac function has somewhat stabilized to assess his ejection fraction and to determine the for systemic coagulation if he has a low ejection fraction. 3. gastrointestinal: patient remained relatively stable from a gastrointestinal standpoint. he continued to complain of abdominal pain, however those are believed to be due to urinary obstruction which was relieved after straight catheterizing him and finding 1000 cc in his bladder. he had diarrhea during hospital course, but numerous samples were sent for clostridium difficile and all of those were negative. we obtained several imaging studies of his belly all of which revealed no evidence of obstruction or lesions to explain abdominal pain. it must be noted that abdominal pain waxed and wane together with his mental status. additionally, consultation was obtained with speech and swallowing service. they performed a video swallow which revealed possible aspiration with some liquids, therefore their recommendation included thick and nectar consistency type diet while awaiting for improvement in his mental status and overall function before advancing to thin liquids. 4. infectious disease: on initial presentation, the patient had occasional fevers as well as a white count, however search for infectious source was unrevealing. he received a full seven day course of ceftriaxone for possible pneumonia during his stay on the regular medical floor. the only evidence of infection was an equivocal urinalysis which revealed some white blood cells and bacteria. the urine culture is negative. he received a short course of ciprofloxacin for potential urinary tract infection. there was no other source of an infectious process and his fevers resolved. 5. musculoskeletal: during his stay on the medical floor, the patient was found to have a significant amount of right shoulder pain. an x-ray revealed no signs of fracture or dislocation. the consultation with the orthopedic service was obtained and their opinion was that this is most likely a chronic rotator cuff injury. would of liked to obtain a mri of his shoulder to further characterize this, but given patient's mental status, this is an unrealistic test at this point. 6. neuro: patient's mental status remained somewhat altered following his micu stay. apparently he receives very high doses of benzodiazepine, haldol and other medications effecting his mental status. also such medications were discontinued on the medical floor and he had mild improvement in mental status. a consultation with the .................... service was obtained and there feeling is that this is most likely medication induced contusion and delirium which will hopefully resolve as time goes by. an eeg was obtained which showed changes consistent with toxic metabolic picture and no evidence of seizures. 7. renal: patient continued to receive hemodialysis while in the hospital. his electrolytes remained well-controlled and there are no acute issues from a renal standpoint. note, patient makes small amounts of urine, but has somewhat reluctant to void and had required foley catheter for this purpose. condition on discharge: fair. discharge status: to rehabilitation facility. discharge diagnosis: 1. diabetes mellitus. 2. metabolic acidosis, now recovered. 3. status post acute myocardial infarction. 4. right shoulder rotator cuff chronic injury. 5. hypertension. 6. end stage renal disease on hemodialysis. discharge medications: 1. insulin 20 units nph am, 8 units q.h.s. 2. insulin sliding scale. 3. lipitor 10 mg p.o. q.d. 4. plavix 75 mg p.o. q.d. for the next 20 days. 5. lansoprazole 30 mg p.o. q.d. 6. nephrocaps one cap p.o. q.d. 7. aspirin 81 mg p.o. q.d. 8. lopressor 25 mg p.o. b.i.d. 9. lisinopril 2.5 mg p.o. q.d. 10. colace 100 mg p.o. b.i.d. 11. senna two tabs p.o. q.h.s. 12. dulcolax 10 mg p.o. p.r. p.r.n. 13. lactulose 30 mg p.o. q.h.s. p.r.n. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization hemodialysis diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled acute myocardial infarction of unspecified site, initial episode of care mixed acid-base balance disorder polycythemia vera 

Answer: The patient is high likely exposed to