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: the patient was transferred from the medical intensive care unit. for the hospital course in the medical intensive care unit, please refer to medical intensive care unit discharge summary. this is a 76 year old male who presented with drowsiness and altered mental status as well as hyperkalemia and hyponatremia. the patient is an 76 year old male with a history of renal cell carcinoma, transitional cell bladder carcinoma admitted to the emergency department from home and brought by family for altered mental status where the patient was confused and dizzy in the setting of recent urinary tract infection, diarrhea and decreased p.o. intake. similar episodes have occurred multiple times over the last year, all requiring hospitalizations with altered mental status that improved with hydration and treatment of underlying infection. this recent episode began two weeks ago. the patient had diarrhea times one week which had abated spontaneously by the time of admission. the patient was also being treated for stenotrophomonas urinary tract infection on , and then had a ten day course of bactrim. during this time, the patient had decreased p.o. intake. the patient fell at home and was noted to have slurred speech. there were no other medication changes. the patient continued on his intrathecal clonidine, dilaudid and bupivacaine over this time with increased creatinine also noted from , when his creatinine was 1.3 to 2.3 on . the patient was to come to the on the day of admission to the hospital for a routine magnetic resonance scan to rule out brain metastasis and then was to be admitted to the oncology service. however, the patient was noted to be quite somnolent in the emergency department and arterial blood gas was performed that revealed a ph of 7.12, co2 47 and oxygen 123, bicarbonate 19, felt to be consistent with metabolic acidosis without respiratory compensation and primary respiratory acidosis, felt likely secondary to altered mental status. medical intensive care unit evaluation was called and the patient was tried on bipap. arterial blood gas post bipap was 7.24/44/155. the patient was noted to be more alert and appropriate. he was also given kayexalate, calcium carbonate, insulin, d50 for elevated potassium. urine electrolytes were sent. past medical history: 1. renal cell carcinoma, noted to be clear cell type, diagnosed in , status post treatment with gemzar which was completed in . otherwise, the patient had metastases to the lungs, lower sacrum, right femur, status post radiation therapy. the patient is also status post a left partial nephrectomy in , and a right partial nephrectomy in . 2. transitional cell carcinoma of the bladder with metastasis to the penis, status post radiation therapy. the patient was diagnosed in . status post treatment with bcg times twelve. 3. chronic pain, on intrathecal pain pump placed at in , for severe penile pain and internal spasms. 4. urosepsis in , found to be consistent with klebsiella. otherwise, the patient on prior admissions has had methicillin resistant staphylococcus aureus urinary tract infection as well. 5. coronary artery disease, status post coronary artery bypass graft in . four vessel disease. echocardiogram in , revealed left ventricular ejection fraction 60% with 2+ mitral regurgitation and no other abnormalities. 6. biliary stent placed in . 7. deep vein thrombosis in the distal right femoral vein external to the right proximal superficial femoral vein, status post inferior vena cava filter. 8. status post transurethral resection of prostate. 9. history of nephrolithiasis. 10. suprapubic catheter placement for chronic urinary retention. allergies: codeine which causes facial swelling. medications on admission: 1. aspirin 325 mg one p.o. once daily. 2. atenolol 12.5 mg one p.o. once daily. 3. fluoxetine 30 mg one p.o. once daily. 4. neurontin 300 mg one p.o. three times a day. 5. prevacid 30 mg one p.o. once daily. 6. magnesium oxide 400 mg one p.o. once daily. 7. daily multivitamin. 8. colace 100 mg one p.o. once daily. 9. cranberry capsules 405 mg one p.o. twice a day. 10. xylocaine 5% jelly to penis p.r.n. 11, bupivacaine, dilaudid and clonidine pump which is a pump. family history: significant for mother who expired secondary to cervical cancer, father who had malaria and died from etoh related complications. no other malignancy in the family. social history: the patient has no history of tobacco, no etoh. he lives with wife and daughter who is nearby. the patient is married, has four children in total. the patient did smoke tobacco in the past, however, but no current use. he is the ex-vice president for a company . laboratory data: on admission, white blood cell count was 6.3, 57 neutrophils, 26 lymphocytes, 8 eosinophils, hematocrit 34.7, platelet count 199,000. coagulation studies revealed prothrombin time 13.6, partial thromboplastin time 34.2, inr 1.2. sodium 123 and his baseline is 129 to 139, potassium 7.0, highest potassium prior to this date was 5.5, chloride 97, bicarbonate 19, blood urea nitrogen 47, creatinine 2.3, anion gap 7.0, glucose 115, calcium 9.6. anc 4650. cortisol at 5:00 p.m. is 12.3. ast 26, alt 32, alkaline phosphatase 90, ldh 175, total bilirubin 0.4 and direct is 0.1, albumin 3.4. also, please note that the patient's baseline creatinine is 1.3 to 1.5. subsequent sodium checks in the emergency department were as follows: at 5:00 p.m. on date of admission 125 with a potassium of 6.8, at 10:00 p.m. sodium 126 and potassium 6.2, at 12:00 a.m. sodium 128 and potassium 5.7. arterial blood gases at 9:00 p.m. 7.21/47/123/20, at 10:00 p.m. 7.21/46/130/19 and then bipap was initiated and at 12:00 a.m. 7.24/44/150/20. chest x-ray is significant for bilateral nodular densities consistent with prior metastases, no evidence of congestive heart failure, no infiltrates and possible cardiomegaly. electrocardiogram was significant for sinus bradycardia at 56 beats per minute which the patient has a history, left atrial abnormality, right bundle branch block, left anterior fascicular block and no evidence of st-t wave changes. urine showed red blood cells, 0-2 white blood cells, few bacteria and no leukocytes and no nitrites. urine electrolytes are as follows: sodium 125, urine osoms 287. otherwise, tsh was within normal limits at 0.57. serum osoms were 281. physical examination: temperature was 97.7, blood pressure 140/45, pulse 35 to 47 which is the patient's baseline, respiratory rate 16, oxygen saturation 100% on 100% nonrebreather. generally, the patient is somnolent but arousable, alert and oriented to person and time but not place. head, eyes, ears, nose and throat is normocephalic and atraumatic. extraocular movements are intact. the pupils are equal, round, and reactive to light and accommodation. sclera anicteric. mucous membranes are dry. otherwise, no lesions, exudates or petechiae are noted in the oropharynx. the neck is supple with no jugular venous distention and no lymphadenopathy or evidence of thyromegaly. the heart is regular rate and rhythm, normal s1 and normal s2 with a ii/vi systolic murmur. the lungs are clear with bibasilar crackles noted bilaterally. the abdomen is soft, nontender, nondistended with normoactive bowel sounds. suprapubic catheter is noted and is clean, dry and intact. no surrounding erythema is noted. extremities are free of any cyanosis, clubbing or edema and are warm to touch. dorsalis pedis pulses 2+ are palpated. hospital course: 1. acidemia - again felt consistent to metabolic and respiratory acidosis combined. the patient was initially maintained on bipap and his mental status improved considerably. he was also hydrated with initially normal saline and later changed to bicarbonate with good response. his acidosis largely corrected by the time of discharge when his bicarbonate was 24. 2. hyponatremia - the patient's hyponatremia was initially felt likely to prerenal state given that it was improving with intravenous hydration and his urine electrolytes were not consistent with syndrome of inappropriate diuretic hormone picture. other things that were considered were hypocortisol state with hyponatremia and hyperkalemia, however, the patient had no evidence of hypotension or other findings of hypocortisol state. then hypoaldosteronism was considered. the patient's cortisol levels were sent off and his cortisol levels random and after cortrosyn stimulation test were all above 20 and felt not to be consistent with a hypocortisol state. hypoaldosteronism was entertained and aldosterone level was sent and was pending at the time of this dictation. the endocrinology service was consulted and their differential diagnosis was wide but included hypocortisol state including hypoaldosteronism state. the patient did have a random cortisol checked and cortrosyn stimulation test. again, his cortrosyn stimulation test revealed that his cortisol levels were above 20. the endocrinology service felt that this effectively ruled out hypocortisol state and attention should be turned to hypoaldosteronism state, possible type four rta. the patient did undergo a magnetic resonance scan of his abdomen with particular attention paid to his adrenals which was done prior to discharge but was pending by the time of this dictation. the reason for obtaining this magnetic resonance scan was that the patient did have a history of bladder cancer as well as renal cell carcinoma and it is conceivable that he could have sustained metastatic disease to his adrenal gland. 3. hyperkalemia - again, this is felt secondary to a combination of acute renal failure acidosis. his potassium improved considerably with hydration and p.r.n. kayexalate and insulin and d50. electrocardiogram was checked and revealed no evidence of hyperkalemia associated electrocardiographic changes. acute renal failure was nonoliguric. the patient's creatinine improved with intravenous hydration. urine eosinophils were checked and were negative. again, it was felt likely secondary to prerenal state. the patient's renal function improved considerably with intravenous hydration and by the date of discharge, the patient's creatinine had reduced to 1.7. 4. acute renal failure - the renal service was consulted and felt that hypoaldosteronism state was definitely on the differential diagnosis and aldosterone was sent off but again was pending at the time of discharge. the patient's acute renal failure, however, did respond to intravenous fluids and had almost normalized by the time of discharge. 5. altered mental status - again, somnolence was felt to be secondary to acute renal failure, elevated blood urea nitrogen, acidemia, narcotics. the patient's blood cultures were sent and were no growth to date by the time of discharge. the patient had a magnetic resonance scan of his brain which was performed by the time of discharge but not read. otherwise, the patient's mental status improved considerably and he was at his baseline by the time of discharge. 6. code status - the patient was a full code. communication was with the patient's wife and daughter. the patient's other medical problems remained stable during this hospitalization. discharge diagnoses: 1. renal failure. 2. transitional cell carcinoma. 3. renal cell carcinoma. 4. hyponatremia. 5. hyperkalemia. 6. metabolic and respiratory acidosis. 7. altered mental status. follow-up plans: the patient had an appointment with dr. from the department of hematology/oncology on , at 1:30 p.m. he had an appointment with myrielle , r.n. at the hematology/oncology center on , at 2:00 p.m. the patient was also to have a potassium and sodium drawn on monday, , or tuesday, , and the results were to be faxed to dr. office for interpretation. tests pending at the time of discharge include aldosterone and magnetic resonance scan of head and abdomen. condition on discharge: stable. he was ambulating and tolerating p.o., urinating and having bowel movements without difficulty. his altered mental status, metabolic and respiratory acidosis, hyperkalemia, hyponatremia had resolved. the patient's renal function with creatinine was nearly at baseline by the time of discharge. discharge status: the patient will be discharged to home with vna services and close follow-up. medications on discharge: 1. aspirin 325 mg one p.o. once daily. 2. lansoprazole 30 mg one p.o. once daily. 3. fluoxetine 10 mg three tablets p.o. once daily. 4. docusate 100 mg one p.o. twice a day. 5. lidocaine hcl 5% ointment apply to mucous membranes twice a day p.r.n. 6. kayexalate 10 mg one p.o. q.o.d. 7. nifedipine 30 mg tablet sustained release one tablet p.o. once daily. 8. magnesium oxide 400 mg one p.o. once daily. 9. acetaminophen 325 mg one to two tablets q4-6hours as needed for pain. , m.d. dictated by: medquist36 procedure: non-invasive mechanical ventilation diagnoses: hyperpotassemia hyposmolality and/or hyponatremia coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of malignant neoplasm of bladder mixed acid-base balance disorder personal history of malignant neoplasm of renal pelvis acute kidney failure with other specified pathological lesion in kidney 

Answer: The patient is high likely exposed to