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: bactrim / vancomycin / keflex / biaxin / percocet attending: chief complaint: chest burning major surgical or invasive procedure: left femoral line placement history of present illness: 46yo f with type 1 dm on insulin pump presented to with "chest burning" noted to have hyperglycemia 600s, elevated anion gap. pt recently admitted to in for similar presentation 2 weeks ago. pt describes chest pain substernal radiating to neck and top of arms, but not down arms. lasted hours. no associated sob, v, diaphoresis. in ed, given ntg and mylanta, feels mylanta made pain better. patient feels that pain is most likely heartburn. she states she was on nexium in past, which was not helping her anymore. at she had negative persantine stress test and enzymes. she had a small bowel follow through which was normal and a normal endoscopy. she was started on reglan (but told only to take as needed) and ppi (but also told to take as needed?) she does not recall the name of the new medication. ros: + episode of n earlier today. no sweats. no f/c. no sore throat. no dysuria, vaginal discharge. no diarrhea. no sore throat/ cough. of note, ? if pump is working. last night, when she primed the pump, she had difficulty with it and had to prime it at least 3 times. apparently, the pump has not been checked at in last 2 weeks. patient also describes subjective sensation of food getting stuck in stomach after she eats and then passing quite a bit later. past medical history: dm type 1 with renal and eye manifestations followed by dr. ; last hba1c 10.9% 1/05 hypercholesterolemia goiter, unspec abdominal bruit - - ct abd/pelvis: ca++ mesenteric art.no sig ca++ in aorta or renal art. no aortic aneurysm. s/p cholecystectomy social history: recently moved to from , ma. her endocrinologist at is dr. . no tobacco, rare etoh. is a stay at home mom. 2 9, 12. family history: no family h/o cad. mom-high cholesterol. dad- prostate ca. physical exam: vs: t 98.4 hr 110 bp 131/36 rr 18 o2 99% ra gen: well-appearing thin f nad, alert and oriented x 3. heent: perl. eomi. no scleral icterus. cv: rrr. nl s1, s2. + sem loudest at lusb radiating to carotids b/l, back. lungs: ctab abd: active bs. soft. nd. + audible aortic bruit. tender suprapubically and ? diffusely to percussion. no renal artery bruit. no rebound or guarding. insulin pump site without erythema or tenderness. extr: no edema. dp 2+ b/l. neuro: strength intact throughout. light touch intact. pinprick not tested. groin: left femoral line in place pertinent results: on admission : . ph 7.4, glu (venous) 603, lactate 2.2 wbc 9.4, hgb 14, hct 39.5, plt 183 na 131, k 5.2, cl 91, hco3 18, bun 27, cr 1.3, glu 613, ag 22 . cardiac enzymes x2 - negative . u/a: ph 5.0, glucose 1000, ketones 50; no leukoctyes or nitrite. . ekg: sinus tach at 100bpm, normal axis; flattened tw iii and twi v1; ? slight st depression in ii, iii, avf, v6 (ekg from largely unchanged) . cxr, pa and lateral: flattened diaphragms, with flaring between ribs, and a small heart. no focal infiltrates or consolidations. clear costophrenic angles bilaterally. . serum hcg: negative . on discharge: wbc 5.8, hgb 11.0, hct 31.5, plt 153 na 141, k 4.0, cl 113, hco3 24, bun 15, cr 0.8, glu 124, ag 4 fe 45, tibc 205, ferritin 112, trf 158 ca 7.8, ph 2.7, mg 1.8 . echo: ( notes). - normal lv function >55%, 1+mr brief hospital course: 46yo female with type i dm complicated by retinopathy and nephropathy who presents in dka with burning chest pain that radiated to her neck and arms bilaterally. likely cause of her dka was insulin deficiency a pump malfunction. . 1. dka - she was admitted to the and placed on ivf of ns at 500cc/hr overnight. she was also started on an insulin gtt per the protocol. by morning, she had closed her anion gap and was actually becoming hypoglycemic. her ivf were switched to d5ns and her insulin gtt was held until her fingersticks came back to normal. her insulin gtt was then restarted at a basal rate to match her typical rate on her insulin pump. consulted to check her insulin pump and found that she had bubbles in the line which was likely blocking the flow of insulin. unfortunately, the patient was unable to see the bubbles due to her retinopathy. it was decided to d/c the insulin gtt and place the patient on glargine 20u at 5pm and a humalog sliding scale in a ratio of 1:15g carbohydrates, as the patient is educated in carb counting. the patient did not feel comfortable administering injections due to her deformed r hand and her inability to see the numbers on the syringes well. because of this, it was decided to keep her overnight and discharge her prior to her appointment where her insulin pump will be reattached. . 2. chest pain - she ruled out for mi by negative cardiac enzymes x2 and no ekg changes. she had a negative persantine stress test and normal echo per patient 2 weeks ago at in . it was felt to be gerd/gastroparesis and patient was started on a ppi or h2 blocker (she can't remember the name). in hospital, she felt that her gerd symptoms were improved with mylanta and pantoprazole. she may benefit from gastric motility studies as an outpatient. . 3. anion gap metabolic acidosis - her anion gap was originally 22, but came down to 4. she likely became hyperchloremic due to aggressive fluid resuscitation, so ivf were stopped and the patient was encouraged to continue taking pos. . 4. hyperkalemia - resolved with treatment of her dka. was 4.0 on discharge. . 5. arf - also resolved with treatment of her dka. her cr was 1.3 on admission, but came down to 0.8 which is her baseline. the bump in her cr was likely prerenal in origin. . 6. anemia - her hct was normal on admission, but decreased to 31.4 with hydration. iron studies were sent and are suggestive of an anemia of chronic disease. we recommend follow-up with her pcp for this. . 7. fen - she was on a diabetic diet throughout her admission. she was encouraged to take po fluids rather than ivf. she had bathroom privileges throughout her admission and a foley catheter was never placed. she did complain of mild suprapubic pain while admitted. if suprapubic pain does not improve, her pcp may consider straight catheterization or diagnostic studies to r/o urinary retention/autonomic dysfunction due to her dm. ua and urine cx were negative for infection. . 8. access - l femoral line was placed in the ed per patient request. it was left in throughout the course of her admission. she has had 11 surgeries and now has a deformed r hand an infiltrated iv and thrombophlebitis in the past, so she is reluctant to have peripheral lines. . 9. ppx - she used pneumoboots while in bed. heparin was not indicated as pt was ambulating to commode. was also given ppi + maalox. bowel regimen to prevent constipation. . 10. code status - full . 11. dispo - to home, with close follow-up by . medications on admission: 1. humalog insulin pump. 0.7 u/hr 12 am to 7 am ; 0.8 u/ hr 7am -12 am 2. prinivil 10mg 1 once a day 3. lipitor 10mg 1 once a day 4. advair discharge disposition: home discharge diagnosis: primary diagnosis: 1. diabetic ketoacidosis 2. anemia secondary diagnosis: 1. diabetes mellitus type 1 complicated by retinopathy, nephropathy 2. hypercholesterolemia 3. h/o goiter 4. h/o abdominal bruit discharge condition: stable, with fs in 160s-200s and anion gap of 4. discharge instructions: please call your pcp if you develop any of the following symptoms: dizziness, sweating, lightheadedness, chest pain, burning or tightness, shortness of breath, nausea or vomiting, or with any other troublesome symptoms. followup instructions: please follow-up with dr. on thursday, at 11am and with at 1pm. please set up follow-up with your pcp weeks for your reflux disease and possible gastroparesis. you may benefit from a gastric motility study, if you have not had that already. you also have a slight anemia which should be followed by your pcp. cxr also shows signs of hyperinflation. this should be compared to old films by your pcp as your pcp may recommend pulmonary function tests as an outpatient. procedure: venous catheterization, not elsewhere classified diagnoses: acidosis hyperpotassemia anemia of other chronic disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere esophageal reflux acute kidney failure, unspecified diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled background diabetic retinopathy diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled insulin pump status 

Answer: The patient is high likely exposed to