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: neck and back pain, found to have severe hyponatremia major surgical or invasive procedure: central line right ij placed history of present illness: ms is a 86 year old woman presenting for back pain and incidental hyponatremia noted in ed to 113 compared to baseline of near 140. she has a history of type i diabetes, hypertension, hyperlipidemia, coronary artery disease, hypothyroidism, gerd and chronic atrophic gastritis. she currently lives in assisted housing at , in the independant living portion of housing. her presentation begins 3 weeks prior to this ed visit: she went walking with her daughter at this time along the and fell while using her walker, sustaining abrasions to her elbows. thereafter, she developed back pain that progressed over the last two weeks resulting in an evaluation at the er on . lumbar x-ray was obtained which did not reveal fracture. she was given tramadol and discharged. no labs were drawn at this point. she returned to her , where she was transferred to the skilled nursing facility for pain control. despite this, her pain continued unabated and she presented today to ed. her sodium upon presentation was noted to be 117. over the past two weeks, her po intake has been quite poor. denies vomiting, nausea, or diarrhea. she has been constipated for the last five days with progressive distension of her abdomen. she denied dizziness, syncope or seizure activity. she has had prior admissions for hyponatremia a year ago which was secondary to osmotic diuresis in setting of hyperglycemia which resolved with fluid resuscitation. review of systems today is also positive for a significant amount of diureses over the past few days despite poor po intake and hydration. her last tsh was somewhat supratherapeutic in at 4.9 - she has had thyroid failure for 20-25 years on synthroid. her last sodium prior to this visit was 139 in . today, she is oriented to person, to place, but not to time; she is vaguely able to recount her reason for admission; her daughter states she is quite confused. no new medications. in our emergency department today, she received a ct abdomen / pelvis - with no obvious fracture as source of her back pain. colon is full of stool with some distension of her colon but no obstruction. she was admitted to the micu for evaluation and treatment of her hyponatremia. at time of transfer, she had no acute complaints and has the orientation described above. past medical history: 1. dm - type i x 50+ years 2. osteoporosis. 3. hypertension, hyperlipidemia, and coronary artery disease. - mi at 65yo, medically treated 4. hypothyroidism, on replacement. 5. vitamin d deficiency, on replacement. 6. gerd -- endo/mild hh with a mild esophagitis and presbyesophagus with a motility study showing a normal les but 50% failed contractions . 7. chronic atrophic gastritis with intestinal metaplasia -- rule out pernicious anemia. 8. h/o seizure - last in 9. constipation . prior surgical procedure: 1. appendectomy. 2. tah-bso 3. endoscopy in the and a colonoscopy, questionable time social history: patient lives in assisted care facility at - she has a daytime caretaker . she lost her husband of 62 years 2 years ago. she has three children. her daughter lives in and is her hcp. pt graduated from college with a degree in social work. she was a homemaker. she used to smoke a little years ago. denies any etoh. family history: nc physical exam: on admission: vs: hr 79, bp 146/60, rr 12, 96% ra, temp 98 gen: caucasian female, pleasant, but hard of hearing, in no apparent distress; euvolemic in appearance neck: supple, no lymphadenopathy, no thyromegaly cardiac: nl s1/s2 rrr no murmurs appreciable pulm: clear bilaterally with normoactive breath sounds abd: soft but has distended abdomen, tympanic, normoactive bowel sounds ext: no edema noted discharge exam vss gen: patient lying comfortably in bed nad a+ox3 heent: mmm oropharynx clear neck: supple no thyromegaly cv: rrr no m/r/g resp: ctab no w/r/r abd: soft nt nd bs+ extr: no le edema good pedal pulses bilaterally derm: decubitus ulcer noted on back and coccyx neuro: cn 2-12 grossly intact non-focal psych: normal affect and mood pertinent results: ct abd/pelvis findings: small-to-moderate simple pleural effusions are seen bilaterally, with compressive atelectasis of the dependent lower lobes. the heart is enlarged. there is no pericardial effusion. moderate coronary arterial calcification is present. the liver enhances homogeneously, without focal lesions or biliary dilatation. the gallbladder is normal. the adrenal glands and spleen are normal. small sub-centimeter cystic areas are seen in the body and uncinate process of the pancreas. the main pancreatic duct is within normal limits. both kidneys enhance and excrete contrast symmetrically, without evidence of hydroureteronephrosis. a subcentimeter hypodense lesion in the interpolar region of the right kidney (2:28) is too small to characterize in this study. the abdominal aorta has moderate atherosclerotic calcifications, extending into both iliac arteries, without aneurysmal dilation. calcifications are seen at the origins of the celiac axis and sma. the renal arteries, and inferior mesenteric artery are patent. no significant retroperitoneal or mesenteric lymphadenopathy is seen. there is no intra-abdominal free fluid or air. there is a moderate amount of fecal load throughout the entire colon and rectum. ct of the pelvis with intravenous contrast: the urinary bladder, distal ureters, rectum and sigmoid colon are normal. the uterus is not visualized. no pelvic lymphadenopathy or free fluid is seen. bones and soft tissues: old fractures of t9, 10, 11 are seen with evidence of prior vertebroplasties. no new fractures are seen in the lumbosacral spine. bilateral pars defects at l5 seen with grade i anterolisthesis of l5 on s1. irregularity in the right superior and inferior pubic rami suggest old healed fractures. degenerative changes are seen in the pubic symphysis. bilateral sacroiliac joint degenerative changes are noted. impression: 1. no acute visceral traumatic injury or fracture identified in this study. 2. bilateral moderate-sized simple pleural effusion with compressive atelectasis of the dependent both lower lobes. 3. extensive atherosclerotic disease of the abdominal and iliac arteries, without aneurysmal dilation. 4. large fecal load throughout colon. . cxr findings: tip of right internal jugular vascular catheter is partially obscured by vertebroplasty material in the adjacent thoracic spine. with this limitation in mind, it appears to traverse at least to the level of the cavoatrial junction. there is no evidence of pneumothorax. cardiac silhouette is upper limits of normal in size. new bibasilar opacities have developed, appear to correspond to areas of basilar atelectasis and pleural effusions on recent ct abdomen study of one day earlier. . head ct noncon findings: there is no evidence of hemorrhage, edema, mass effect, or infarction. prominence of the ventricles and sulci reflects age-related global atrophy. areas of periventricular and subcortical white matter hypodensity likely reflect sequelae of chronic small vessel ischemic disease. there is no evidence of fracture. the visualized paranasal sinuses and mastoid air cells are clear. there are calcifications of the carotid siphons bilaterally. impression: no evidence of abnormalities related to recent trauma. findings suggesting chronic small vessel ischemia. . discharge labs 04:11am blood wbc-5.8 rbc-2.91* hgb-8.2* hct-26.2* mcv-90 mch-28.2 mchc-31.3 rdw-19.2* plt ct-226 04:11am blood glucose-147* urean-18 creat-0.7 na-131* k-4.6 cl-97 hco3-27 angap-12 04:11am blood calcium-8.5 phos-3.0 mg-2.0 brief hospital course: reason for icu admission: 86 yo f iddm, hypothyroidism, found with with symptomatic hyponatremia. . # hyponatremia: on presentation pt was found to have hyponatremia with sodium of 116. it was initially felt that her volume status was hypovolemic-euvolemic. urine sodium suggestive of siadh, potentially in the setting of pain. tsh and am cortisol within normal limits. ct head did not show any evidence of cerebral process which could be causing salt-wasting. initially pt was given hypertonic saline at a slow rate but developed hypotension in the setting of decreased po intake to 80/40 requiring boluses of iv ns. urine output had also dropped off and this was felt hypovolemia; resolved with fluid resuscitation. blood sodium was trended q4hourly. her sodium continued to trend up and hypertonic saline was discontinued in favor of ns. her fluid intake was restricted to 1500 cc daily and started on salt tabs. her mental status improved with increasing serum sodium. nephrology felt that this was likely siadh from her acute pain. she will continue on daily salt tabs and needs follow sodium check on . #agitation - pt with baseline dementia. she was extremely agitated on admission. she required central line placement for hypertonic saline and required 50mg tramadol and 2.5mg zyprexa for agitation. these medications were extremely effective. pt also required another 1x dose of 2.5 zyprexa overnight. would use haldol in the future should pt require chemical restraint as zyprexa could contribute to siadh. . #back pain - pt continued to complain of back pain relieved by lidocaine patch. ct did not show any acute fracture, but did show some old fracture s/p vertebroplasty. she will need to continue working with physical therapy. if the pain is not improving in the next week, can consider further imaging with mri of the back. . # dmi: brittle diabetes. currently on lantus 6 units qhs and novolog sliding scale. . on discharge from she should follow up with diabetes center . #transitional issues: -follow up sodium on . if sodium increasing to 135 can liberalize fluid intake to 2l daily. medications on admission: 1. alendronate 70 mg tablet sig: one (1) tablet po once a week. 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. diltiazem hcl 120 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 4. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a month. 5. lantus 100 unit/ml solution sig: eight (8) units subcutaneous at bedtime. 6. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 7. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 9. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. senna 8.6 mg capsule sig: one (1) capsule po at bedtime. 12. multivitamin tablet sig: one (1) tablet po daily (daily). 13. humalog 100 unit/ml solution sig: as per sliding scale units subcutaneous three times a day. 14. os-cal 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po once a day. 15. augmentin 875-125 mg tablet sig: one (1) tablet po twice a day for 6 days. discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 3. vitamin d2 50,000 unit capsule sig: one (1) capsule po once a day. 4. lantus 100 unit/ml solution sig: one (1) 6 units subcutaneous at bedtime. 5. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 8. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po bid (2 times a day) as needed for constipation. 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 11. multivitamin tablet sig: one (1) tablet po once a day. 12. os-cal 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po once a day. 13. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* 14. insulin aspart 100 unit/ml solution sig: one (1) subcutaneous tid with meals: please follow sliding scale. discharge disposition: extended care facility: - discharge diagnosis: hyponatremia metabolic encephalopathy back pain discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with back pain and acute confusion and found to have a low sodium. it corrected with hypertonic saline and fluid restriction. your confusion improved as the sodium improved and on discharge your sodium was 131. please continue taking salt tabs daily and work with the physical therapist for your back pain. followup instructions: department: radiology when: thursday at 11:30 am with: radiology building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 10:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 11:00 am with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension hyposmolality and/or hyponatremia unspecified acquired hypothyroidism other and unspecified hyperlipidemia osteoporosis, unspecified old myocardial infarction other and unspecified special symptoms or syndromes, not elsewhere classified metabolic encephalopathy diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled backache, unspecified unspecified vitamin d deficiency other specified disorders of esophagus atrophic gastritis, without mention of hemorrhage dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to