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: no known allergies / adverse drug reactions attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: 73yo m w/ hx of cad s/p 4v cabg ()and pci w/ lad stent, poorly controlled iddm, hld, copd, and ckd (baseline cr 3.5)presented to sunday am after being found unresponsive at home. ems fs at the scene was 63. in the ed was notable for bun 98, cr 5.0, troponin 1.85, ck-mb 25.9 and bnp>5000. ekg was notable for sinus tach, lvh with 1-2mm st depressions in the lateral leads. head ct was neg for intracranial pathology. he was started on a hep ggt and given rectal aspirin and transferred to the osh ccu. they could not plavix load or give beta blocker because not taking po. he was evaluated by the renal team and given his acute on chronic renal failure with hyperkalemia (peak 5.5) metabolic acidosis and volume overload, a right ij vas-cath was placed and he was emergently dialyzed with 1.2 kilos of fluid removed and creatinine fell to 3.7. his peak troponin i 23.9 and ck-mb 57.1 (mb peaked on ). he was maintained on heparin ggt. a cardiac echo was done which demonstarated an ef of 38% hypokinesis of mid inferoseptal, mid inferior, mid inferolateral, basal inferolateral, basal anteroseptal, basal inferoseptal and basal inferior segments. his blood sugars fell into the 30's while in the ccu and he was placed on d10 and maintained his blood glucose in the 70's-90's. he was transefered to ccu for further care. on arrival to the floor, patient remains altered. he is agitated and not oriented to person, place or time. he is unable to give any history at this time. his niece, his hcp, was and the situtation was discussed. she reports that his medication list is unchanged from his recent discharge from and that the patient is responsible for administration of his own medication. she reports that he has a history of hypoglycemia episodes, most recently an admission to from /12. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: -cabg: 4 vessel in -percutaneous coronary interventions: cath with stent to lad and lcx on -pacing/icd: 3. other past medical history: chf (ef <30%) ckd with baseline cr (3.0-4.0) pvd s/p sfa and dp bypass left iliac stenting s/p appendectomy s/p l 2nd toe amputation social history: social history is significant for current tobacco use, thenpatient has smoked up to 2 and ppd for over 55 years, quit briefly for 6 months, now smoking again. there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: admission physical exam: vs: t=97.5 bp=163/57 hr=78 rr=16 o2 sat=99% on ra general: wdwn male in nad. not oriented to person, place, or time. mildly agitated at times. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 8 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 3/6 systolic ejection murmer best heard 2nd intercostal space. no r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ left: carotid 2+ femoral 2+ dp 1+ discharge physical exam: vs: t 98.0 bp 144/61 hr 57 rr 18 o2 96% general: awake, alert, oriented to , . struggles with days of the week in reverse heent: oral mucosa without erythema, dry mucous membranes heart: regular rate and rhythm, grade ii/vi systolic murmur, normal s1 and s2. pulm: soft bibasilar crackles that don't clear with cough. good air movement, no wheezes, rales, ronchi. abd: soft, nontender, nondistended, normoactive bowel sounds, no organomegaly. ext: right bka, good dorsalis pedis pulse. pertinent results: 03:33am blood wbc-5.6 rbc-3.14* hgb-10.2* hct-31.8* mcv-101* mch-32.5* mchc-32.1 rdw-14.7 plt ct-130* 09:26pm blood glucose-115* urean-64* creat-3.7* na-145 k-4.0 cl-108 hco3-21* angap-20 03:33am blood glucose-104* urean-65* creat-3.8* na-147* k-3.8 cl-109* hco3-20* angap-22* 08:37pm blood glucose-224* urean-73* creat-4.1* na-143 k-4.0 cl-105 hco3-21* angap-21* 08:37pm blood ck(cpk)-423* 03:33am blood alt-24 ast-47* ld(ldh)-379* alkphos-123 totbili-0.4 03:33am blood calcium-7.2* phos-6.2* mg-2.1 09:06pm blood type-mix po2-109* pco2-39 ph-7.33* caltco2-21 base xs--4 09:06pm blood lactate-0.9 03:33am blood tsh-1.6 ct head: no acute abnormalities. no hemorrhage. cxr: right hd line terminating at the low svc. no pneumothorax or effusion detected. discharge labs: 07:35am blood wbc-5.8 rbc-2.66* hgb-8.6* hct-27.5* mcv-104* mch-32.5* mchc-31.4 rdw-14.8 plt ct-108* 01:48am blood pt-12.2 ptt-29.9 inr(pt)-1.1 07:35am blood glucose-219* urean-96* creat-4.2* na-147* k-4.9 cl-111* hco3-24 angap-17 07:42am blood alt-23 ast-26 alkphos-115 totbili-0.3 07:42am blood ggt-69* 09:26pm blood ck-mb-19* mb indx-1.9 ctropnt-1.86* 07:35am blood calcium-8.2* phos-4.6* mg-1.7 iron-pnd 03:33am blood tsh-1.6 01:48am blood vitb12-566 09:06pm blood lactate-0.9 brief hospital course: 73 year old male with pmhx cad s/p 4v cabg ()and pci w/ lad stent, poorly controlled iddm, hld, copd, and ckd who presented to the hospital with altered mental status that was complicated by nstemi, hypoglycemia, and hypernatremia. #altered mental status: pt presented to the osh per report he was delirious and agitated, which seems to have been waxing and . on transfer to he continued to be altered, a&ox0. he recieved a workup that showed a clear head ct, normalized blood glucose, normal lfts without physical exam findings of encelpalopathy, and did not improve following urgent dialysis. his mental status gradually improved over hospital day 1. he gradually became more agitated and on hd 3 he required haldol 2.5mg x2 following the patient punching a member of the staff. he continued to be agitated and pyschiatry was consulted. they felt that this most likely was acute delerium and favored a standing dose of haldol with prn for breakthrough agitation. he had a workup of other causes of his ams including tsh, dosing with thiamine and folate, infection workup, head ct, lfts, b12. all of which were non-diagnostic. at transfer to the floor, he had no more episodes of agitation. his haldol and seroquel were tapered and he eventually became oriented to , . # renal failure: secondary to htn and dibetes, admitted with chronic kidney disease stage 4-5, baseline creatinine of ~3.5 with egfr ~15. he received dialysis due to heart failure and fluid overload as well as electrolyte control. during this admission, his cr continued to steadily rise into the mid 4's. he has been evaluated for vein mapping and planning on establishing he is currently euvolemic and making about 50cc of urine an hour. his electrolytes are medically controlled and he has no acute indications for dialysis, however he will likely need dialysis soon as an outpatient. he has had vein mapping here . # nstemi: the patient has a hx of extensive cad and is s/p 4v cabg and in the setting of his altered mental status he had elevated cardiac enzymes (mb peaked at 57) and echo with question of worsened wmas. ecg with st depressions in inferior and lateral leads, but unchanged compared to prior, consistent with abnormal repolarization. he recieved full dose asa rectally and was started on heparin ggt. due to his ams he was unable to take po medications and plavix was not able to be given. his biomarkers trended down on admission. he remained hemodynamically stable. he has had no complaints of chest pain. # hypernatremia: on admission to osh the patients na was 145. on transfer to his na rose to 147 and he was started on d5w. this was gradually corrected and normalized at 143. he was monitered off d5w and his sodium remained normal for the remainder of his hospitalization. he is hypernatremic at discharge, but is also dry and encouraged to increase po intake. # hypoglycemia: pt has been hypoglycemic on recent admission on to and was found to have a bs of on . per niece, he doses his own insulin and she is not sure if he is dosing it correctly. he required dextrose infusion at osh to maintain glucose levels, however on transfer to hisblood glucose remained stable in the 120s off of dextrose. he was placed on a sliding scale of insulin without and basal insulin and his blood glucose was maintained. it was felt that this initial hypoglycemia was to to overdosing of a long acting basal insulin. this appears to best fit the clinical picture as he had no further episodes since his inital hospitalization at the outside hospital. # dm2: as noted above the patient was admitted with concern for hypoglycemia and his home insulin was held. while recieving d5w to correct for hypernatremia his bllod glucose began to rise into the 200's. the patient was placed on a riss and his blood glucose was monitored during his hospitalization. # chronic systolic chf: baseline patient has ef 45%. he was found to have an estimated ef of 38% based on echo at osh on . no evidence of acute decompensation during hospitalization, with no rales, peripheral edema or elevated jvp. he maintained his volume status and had no episodes of sob or incraased o2 requirements. # hypertension: pt has a history of this and is controlled with metoprolol, hydralazine, and imdur at home. bps elevated on arrival with sbp into 170's. given the patients ams and inability to take po medications he was placed on iv metoprolol and iv hydrazine with sbps in the 120's. he was eventually transitioned to po hydralazine and metoprolol. his furosemide has been held, and his blood pressures have remained stable. transitional issues: - renal follow up medications on admission: preadmission medications listed are correct and complete. information was obtained from family/caregiver . 1. clopidogrel 75 mg po daily 2. hydralazine 25 mg po bid 3. isosorbide dinitrate 30 mg po tid 4. metoprolol tartrate 25 mg po bid 5. simvastatin 10 mg po qhs 6. tamsulosin 0.4 mg po hs 7. nephrocaps 1 cap po daily 8. calcium acetate 667 mg po tid w/meals 9. sodium bicarbonate 1300 mg po tid 10. furosemide 80 mg po daily 11. aspirin ec 81 mg po daily 12. glargine 6 units dinner insulin sc sliding scale using hum insulin discharge medications: 1. aspirin 325 mg po daily 2. calcium acetate 667 mg po tid w/meals 3. clopidogrel 75 mg po daily 4. hydralazine 25 mg po bid 5. glargine 6 units dinner insulin sc sliding scale using hum insulin 6. metoprolol tartrate 50 mg po bid 7. nephrocaps 1 cap po daily 8. sodium bicarbonate 1300 mg po tid 9. tamsulosin 0.4 mg po hs 10. heparin 5000 unit sc tid 11. lidocaine jelly 2% (urojet) 1 appl tp prn straight cath 12. nicotine patch 14 mg td daily 13. nitroglycerin patch 0.2 mg/hr td q24h please have patch on for 12 hours. 14. quetiapine fumarate 12.5 mg po daily please give at 5pm 15. senna 1 tab po bid:prn constipation 16. vitamin d 50,000 unit po 1x/week (sa) 17. atorvastatin 80 mg po daily 18. calcitriol 0.25 mcg po daily 19. docusate sodium 100 mg po bid:prn constipation 20. glucagon 1 mg im q15min:prn hypoglycemia protocol 21. folic acid 1 mg iv q24h 22. acetaminophen 1000 mg po q8h pain 23. simvastatin 10 mg po qhs discharge disposition: extended care facility: healthcare of discharge diagnosis: renal failure with altered mental status. discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking part in your care while at . you were transferred to this hospital from another hospital to which you were admitted when you were found down at home. the cause of your collapse is unclear, but you were found to have a very low blood sugar. you were also found to have heart failure and you had to have hemodialysis to remove the fluid that accumulated from low output from the heart. when you were transferred here, you were maintained in the intensive care unit until your renal and cardiac function stabilized. once they did, you were transferred to the regular hospital floor where your condition improved. your heart has been functioning well, and your blood sugars have been well controlled. unfortunately, your kidney function has not returned to what it was before this episode. while you do not currently need to be in the hospital to manage your kidneys, it is important that you see a nephrologist to continue managing. once again, it was a pleasure to meet you, and i wish you the best going forward. sincerely, md followup instructions: please see dr. on thursday at 3:30. greater assocs ( when discharged from rehab, please call regular pcp . , . procedure: hemodialysis diagnoses: hyperpotassemia thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status subendocardial infarction, initial episode of care congestive heart failure, unspecified toxic encephalopathy acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of bronchus and lung coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin chronic systolic heart failure other postprocedural status diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status other toe(s) amputation status 

Answer: The patient is high likely exposed to