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: lethargy major surgical or invasive procedure: picc line placement ng tube placement history of present illness: 84f, history of advanced dementia (nonverbal for 4 years and nonambulatory), dm2, hypertension, chf (ef unknown) brought to from due to decreased responsiveness and admitted to the icu for hyperglycemia. at baseline she has been minimally verbal, if at all, for 4 years, however she usually is able to respond somewhat to interaction with smile to facial recognition however for the last three weeks she has not been able to do this. today patient was appearing leghargic and unable to swallow meds or food. she was febrile to 101 at the facility, and with a sodium of 160. she is currently being treated for uti with im ceftriaxone (day3). she has had poor po intake for months and been losing weight. in the ed, 99.6 132 164/99 20 96% 3l ra. labs notable for lactate 3.6, glucose 448, na 162, inr 1.4, cr 1.7, wbc 12.4, ag of 18, ua concerning for uti. ekg showed nsr, cxr showed no infiltrate, head ct negative. she was given insulin gtt, vanc/zosyn, 2l ns, now getting ns with k. vitals on transfer 111 154/66 26 100% on ra. foley in and making urine. 1piv will attempt second. on arrival to the icu, vitals were t:97.2 p106 bp117/54 rr23 98%ra she was unresponsive and unable to contribute to the interview. her daughter reported that she appeared to be at her baseline mental function. review of sytems: unable to obtain past medical history: - diabetes mellitus type 2 - hypertension - dementia - congestive heart failure ef unknown - chronic kidney disease, baseline creatinine unknown social history: born in , moved to as adult. no history of drinking or smoking. retired nurse's aid. lives in . family history: father hypertension denies history of diabetes, coronary artery disease. physical exam: admission vitals: t:97.2 p106 bp117/54 rr23 98%ra general: elderly cahcectic appearing female eyes and mouth open, unresponsive to verbal stimuli, no resp distress heent: surgical pupils bl, l>r ansiocoria, aclera anicteric, mucous membs dry, poor dentition neck: supple, jvp not elevated, no lad lungs: poor inspiratory result due to unresponsiveness. clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: tachycardiac, regular rate, normal s1 + s2, no murmurs, rubs, gallops abdomen: midline surgical scar, soft, non-tender, non-distended, bowel sounds present, gu: foley in place ext: bl contractures in hands, warm, well perfused, 2+ pulses, no edema. neuro: unresponsive, moving all extremities withdrawing all ext to pain. pertinent results: admission labs 01:20pm blood wbc-12.3* rbc-4.58 hgb-13.8 hct-43.0 mcv-94 mch-30.1 mchc-32.1 rdw-14.4 plt ct-228 01:20pm blood neuts-77.9* lymphs-16.0* monos-5.3 eos-0.3 baso-0.7 01:02pm blood glucose-471* urean-47* creat-1.7* na-160* k-4.1 cl-123* hco3-18* angap-23* 06:51pm blood calcium-9.0 phos-1.2* mg-2.2 01:20pm blood osmolal-375* 01:08pm blood lactate-3.6* cardiac enzymes 01:20pm blood ck-mb-2 01:20pm blood ctropnt-0.04* 06:51pm blood ck-mb-3 ctropnt-0.04* discharge labs 04:47am blood wbc-5.0 rbc-3.17* hgb-9.4* hct-29.1* mcv-92 mch-29.7 mchc-32.3 rdw-14.1 plt ct-162 05:03am blood glucose-190* urean-10 creat-0.7 na-140 k-4.0 cl-105 hco3-26 angap-13 04:47am blood calcium-8.0* phos-2.3* mg-1.7 head ct findings: no hemorrhage, edema, large masses, mass effect, or acute infarct. periventricular and subcortical white matter hypodensities are consistent with small vessel ischemic disease. marked ventricular and sulcal prominence is increased from prior study and is related to global atrophy. no fracture identified. the mastoid air cells are clear. large amount of cerumen noted in external auditory canal. air-fluid levels and aerosolized secretions noted within the sphenoid sinus as well as partial opacification of the ethmoid air cells. no soft tissue swelling identified. the globes are unremarkable. impression: no acute intracranial hemorrhage. acute sinus disease chest (pa & lat) study date of impression: no acute cardiothoracic process. brief hospital course: assessment and plan: 84 yo f with advanced dementia (nonverbal for 4 years and nonambulatory), dm2, htn, brought from for ams and admitted to the icu for hyperosmolar hyperglycemic state and sepsis secondary to uti. # delirium on dementia: according to the report, patient is non-verbal at baseline; however, lethargy and inability to tolerate oral intake x 3 days represented an acute change. according to her daughter, she appeared close to baseline on admission to icu though she was not tolerating oral intake. head ct was negative for acute hemorrheagic stroke, tsh and b12 were normal. the delirium was attributed to hyperglycemia, hypernatremia, and urinary tract infection; however, despite corrections of her electrolytes, sugars, and treatment of her uti, she still has not been able to demonstrate the ability to swallow safely. she was evaluated by speech and swallow therapist with the following recommedations: recommendations: 1. po diet: nectar-thick liquids, pureed solids. 2. meds crushed with applesauce. 3. 1:1 supervision with all po intake. 4. tid oral care. 5. feed pt only when awake and participatory. 6. check oral cavity for residue following pos. # hyperosmolar hyperglycemic state/diabetes mellitus type 2, uncontrolled, with complications: patient had altered mental status, elevated seurm osms, and serum glucose with anion gap acidosis. though urine was positive for ketones patient has had very poor oral intake x 3 days and decreased po intake x 1 month, ketonuria is related to starvation ketosis rather than dka. she was treated with agressive fluid hydration and insulin drip. her acidosis improved, anion gap closed and she was taken off of the insulin drip and changed to insulin sliding scale. # urinary tract infection: u/a was grossly positive with leukocyte esterase, many wbc and bacteria. she has been treated with ceftriaxone im x 3 days. culture data from revealed proteus sensitive to ceftriaxone. she briefly received meropenem while in the icu until culture from returned no growth. antibiotics were then changed to ceftriazone iv to complete a 7 day course, final day . # hypovolemic hypernatremia: related to poor po intake and exacerbated by osmotic diuresis from hyperglycemia. on admission, sodium corrected for glucose is 168. free water deficit was 3.5l. she was treated with aggressive fluid resuscitation as above and serum sodium trended down. # acute on chronic renal insufficiency: according to past medical history from nursing home patient has ckd, baseline creatinine unknown. creatinine trended down to 1.0 with fluids. # chronic congestive heart failure: ef unknown. patient appeared hypovolemic on exam on admission and was euvolemic on discharge. # hypertension: she was gradually restarted on metoprolol and lisinopril as tolerated. # goals of care: after several discussions, the patient's hcp decided not to pursue peg tube for further nutrition. i counseled the daughter to use morphine for any discomfort or shortness of breath. i also counseled the daughter that she can try to feed her mother for , but she may aspirate. finally, the daughter agreed that rehospitalization would not further benefit her mother at this point. she would like to pursue hospice care at . # code: dnr/dni # communication: patient daughter (hcp) h c medications on admission: multivitamin daily glipizide 2.5 mg acetaminophen 650 mg calcium 600 + d(3) 600 mg (1,500 mg)-400 unit tab metoprolol tartrate 50 mg acetaminophen 650 mg q6-8 hrs prn bisacodyl 10 mg pr daily prn milk of magnesia 400 mg/5 ml oral susp 30ml daily prn fleet enema daily prn no bowel movement to milk of mag. discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): as able. 2. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): as able. 3. insulin lispro 100 unit/ml solution sig: 0-10 units subcutaneous asdir (as directed). 4. acetaminophen 650 mg suppository sig: one (1) suppository rectal tid (3 times a day) as needed for pain, fever. 5. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: 5-15 mg po q2 hrs as needed for pain or shortness of breath. disp:*20 ml* refills:*0* discharge disposition: extended care facility: - discharge diagnosis: delirium on dementia hypernatremia urinary tract infection discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: was admitted for increasing confusion and was found to have high sodium levels in her blood and a urinary tract infection. both have been corrected; however, her mental status has not improved much. she was started on tube feeds through a nasogastric tube. the family has decided not to pursue a peg tube. she will eat for only. followup instructions: she will be pursuing hospice care at . procedure: enteral infusion of concentrated nutritional substances insertion of indwelling urinary catheter central venous catheter placement with guidance diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified unspecified disorder of kidney and ureter pressure ulcer, lower back do not resuscitate status alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia delirium due to conditions classified elsewhere pressure ulcer, stage ii diabetes with hyperosmolarity, type ii or unspecified type, not stated as uncontrolled bed confinement status other speech disturbance 

Answer: The patient is high likely exposed to