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: dka, hypotension major surgical or invasive procedure: cardiac catheterization history of present illness: mrs. is a 41-year-old female with history of type 1 dm type 1, coronary artery disease (cad) s/p mi and cardiac catheterization with bare metal stent to her left anterior descending in who presented with acute onset of nausea and vomiting at 8 am this am. she reports that she was jogging at the time. in the , emergency department she was found to have an elevated blood sugar of 420 with an anion gap of 17. she had trace ketones in her urine. she was started on an insulin drip for diabetic ketoacidosis. she was given iv fluids and transferred to the icu. . at the intensive care unit, she developed substernal chest pain radiating to her arms associated with nausea and vomiting; her chest pain was similar to prior mi in . she denied palpitations but did endorse the sudden onset of dyspnea. she became diaphoretic; her systolic blood pressure decreased to the 80s. in the first set of cardiac enzymes, troponin was less than 0.01. second set of cardiac enzymes: ck of 137, mb of 1.2, index 0.9, troponin < 0.01. she was given 2 sublingual nitroglycerine which caused a further decrease in her blood pressure without improvement of her chest pain which continued to be and substernal. fluids were started through two peripheral iv's (approx. 2.5 l). her sbp decreased to the low 70's and she was then started on dopamine drip. . she was given morphine 0.5 mg for her chest pain. she was placed on supplemental oxygen, 2 liters nasal cannula. ekg did not reveal acute st changes. she was transferred to for cardiac catheterization on heparin and integralin drip given her ongoing chest pain. (initial heparin bolus of 3600 units followed by 600 units per hour. initial integrelin bolus of 180 followed by 10 ml/hr.) she also received 325 mg of aspirin pr but did not take plavix as her blood pressure decreased when she sat up. she was given a dose of levofloxacin 500 mg iv. blood cultures were not obtained prior to transfer. . on review of systems, she reported a recent diagnosis of hepatitis a in sister's child recently adopted from . pt. not previously tested for hepatitis but concerned recent nausea, vomiting could be related. she denied weight loss, fatigue, fever or chills, night sweats, visual changes, dry mouth, chest pain, hematemesis, abdominal pain, diarrhea, hematochezia, rashes, or weakness. . past medical history: - dm, type i: dx 10y ago, on insulin pump, followed at - htn: reports spbs in high 130s, on quinapril - major depressive disorder: on bupropion and trileptal - cervical disc herniation: c5-6, moderate spinal stenosis, stable - vitamin b12 deficiency: monthly injections social history: married, 2 children, works at , exercises daily, denies tobacco and drugs; her husband is involved in her care. family history: no heart disease or dm physical exam: vital signs: temperature 99.1, blood pressure 108/52, heart rate 100, respiratory rate 21. . general: she was alert and oriented x3. heent: sclerae anicteric. pupils are equal, round and reactive to light. neck supple. no lad. lungs: clear to auscultation bilaterally. cardiovascular: regular rate and rhythm. normal s1 and s2. no jvd. abdomen: soft, nontender, nondistended. neurologic: cranial nerves ii through xii intact. pertinent results: at , laboratory data: sodium 133, k 4.2, chloride 96, bicarbonate 20, bun 12, creatinine 0.9, glucose 384, anion gap is 17, white count 11.9, hematocrit 35, platelets 259, alt 29, ast 18, albumin 3.9, calcium 8.7. urinalysis: glucose greater than 1000, ketones greater than 80, trace blood. serum with small ketones. ekg with sinus rhythm at a rate of 114. she had t waves inversions in v1. at , chest x-ray was unremarkable, no mediastinal widening. at : 10:39pm glucose-250* urea n-11 creat-0.8 sodium-139 potassium-4.1 chloride-110* total co2-17* anion gap-16 10:39pm estgfr-using this 10:39pm wbc-19.2*# rbc-3.06* hgb-10.4*# hct-29.7* mcv-97 mch-33.9* mchc-35.0 rdw-15.3 10:39pm wbc-19.2*# rbc-3.06* hgb-10.4*# hct-29.7* mcv-97 mch-33.9* mchc-35.0 rdw-15.3 10:39pm neuts-93.8* bands-0 lymphs-3.4* monos-2.7 eos-0.1 basos-0.1 10:39pm hypochrom-normal anisocyt-1+ poikilocy-occasional macrocyt-1+ microcyt-normal polychrom-occasional ovalocyt-occasional 10:39pm plt smr-normal plt count-280 10:39pm pt-13.0 ptt-46.0* inr(pt)-1.1 09:20pm o2 sat-96 : cardiac catherization- mean pa pressure 20, ra 18, wedge 25, map 77. by report decreased svr. no flow limiting lesions were seen but mild restonsis of lad was noted. brief hospital course: 41-year-old female with type 1 diabetes, coronary artery disease, hypertension, and depression who presents with an acute episode of nausea and vomiting. . #. diabetic ketoacidosis/dm: h/o dm1 x 10 years, mild htn, mild hyperlipidemia. patient initially with fs glucose in 300-400 range at ed, (bs >400 on presentation), with low bicarbonate, and anion gap, consistent with dka. she was placed on a insulin drip in ed and then continued on insulin pump in icu at , which was continued upon transfer. pt was also supported with iv fluids. her anion gap had closed by the time the patient was admitted to micu and the patient was started on an insulin drip for better glucose control. she was transitioned back to home insulin pump on and given glargine 3 hours before transfer to pump. she was continued on glargine 10 units q am consult recommendations and was instructed to continue this daily glargine regimen at home in adddition to her pump. she was instructed also to followup with . dka of unclear etiology. she was admitted last year ()to with precipitant of dka thought to be an actue mi. ruled out at for acute mi with negative cardiac catheterization. ua negative for infection but with >1000 glucose, >80 ketones, trace blood. urine culture were negative. blood culures showed no growth at discharge (but were drawn after one dose of antibiotics at osh). however, leukocytosis (19.2) notable on repeat cbc here. no obvious precipitant to dka- cardiac and infectious workup negative. of note, hepatitis a assay was negative; pt was concerned she had had an exposure. considering the presentation of acute nausea and vomiting, dka may have been precipitated by a gastroenteritis which quickly resolved. . # hypotension: hypotension was thought to be secondary to dehydration on admission. home dosages of beta-blocker and ace inhibitor (for chronic hypertension) were held as the patient was hypotensive. she was also given ntg at for chest pain which likely exacerbated the hypotension. she was volume repleted at . a cta for r/o pe showed pulmonary edema which was likely secondary to fluid overload; we did not replete her volume further. upon discharge the patient was normotensive off her home antihypertensive regimen. she was instructed to follow up with her cardiologist regarding restarting the beta blocker and ace inhibitor. . #. chest pain: given her negative cardiac enzymes there was concern for pe, dissection,or possible sepsis. bp was equal in both arms. cxr w/o mediastinal widening. a d-dimer vte was postive at 1.55 (0-0.99 normal lab) but cta showed no pulmonary embolism or other concerning findings. . #. cad: h/o st elevation myocardial infarction, s/p bare metal stent to mid-lad . repeat cath yesterday negative for new lesion, mild restenosis of lad. risk factors include suboptimally managed dm1 x 10 years, mild htn, mild hyperlipidemia. no tobacco, no family hx early mi. cardiac enzymes negative x2 at . third set of cardiac enzymes at was not concerning for acute mi. we continued asa and atorvastatin as an inpatient. her beta blocker was held secondary to hypertension. . # history of depression: clinically stable. continued on outpatient trileptal. . # fen: maintained on a cardiac, diabetic diet. electrolytes were repleted as needed. . # prophylaxis: she was on heparin drip for possible pe until a pe was ruled out with cta; otherwise, the patient was maintained on sc heparin for dvt prophylaxis. she was eating well so was not on a ppi. . # assess: peripheral ivs. . # communication: patient and husband. . # code status: full code. . . medications on admission: 1. insulin pump regular 0.4 units per hour 2. aspirin 325 mg daily 3. quinapril 10 mg daily 4. atenolol 25 mg daily 5. lipitor 40 mg daily. 6. oxcarbazepine 300 mg daily 7. minocycline 50 mg every other day. 8. vitamin b12 im qmonth discharge medications: 1. insulin pump with novolog 2. aspirin 325 mg daily 3. lipitor 40 mg daily. 4. oxcarbazepine 300 mg daily 5. minocycline 50 mg every other day. 6. vitamin b12 im qmonth 7. glargine 10u daily discharge disposition: home discharge diagnosis: 1. chest pain. 2. diabetic ketoacidosis. 3. hypotension. discharge condition: stable discharge instructions: 1. please return to the er if you have symptoms of chest pain, nausea, vomiting, dizziness or any other concerning symptoms. 2. please call your endocrinologist at , dr. , within one week of discharge for followup. 3. we have changed your insulin pump dosage recommendation, please continue with the current dosing. we have also started you on basal insulin, glargine 10u daily. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension percutaneous transluminal coronary angioplasty status other b-complex deficiencies long-term (current) use of insulin old myocardial infarction diabetes with ketoacidosis, type i [juvenile type], uncontrolled degeneration of cervical intervertebral disc major depressive affective disorder, recurrent episode, unspecified 

Answer: The patient is high likely exposed to