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: severe acute pancreatitis, hypotension, fever to 107 major surgical or invasive procedure: arterial line placement x2 lij cvl right ij hd catheter left ej hd catheter history of present illness: the patient is a 51 year old female with history significant for diabetes mellitus type 2, hypertension and alcohol abuse, and chronic abdominal pain who was transferred from hospital for further management of severe acute pancreatitis and acute kidney injury. she initially presented to osh on with several days of abdominal pain radiating to the back. on arrival to the osh ed, her vitals were t 98.4, bp 133/100, hr 134, and spo2 97% on ra. initial labs showed elevated amylase 183 and lipase 157. her creatinine was 0.3, wbc 10.5, and hct 36.6. ct abdomen in the osh ed showed moderate acute pancreatitis with contiguous inflammation of the duodenem and fatty infiltration of the liver. ruq us showed no evidence of gallstones. she had several prior ed visits for abdominal pain, with negative workup including colonoscopy, egd, and abdominal imaging. prior cta on showed no evidence of pancreatitis. she was admitted to the floor and started on iv fluids with ns at 150 ml/hr. . she decompensated overnight, with continued pain despite narcotics, multisystem failure, and multiple lab abnormalities. in the morning, she was found to have a rise in creatinine from 0.3 to 2.0, lipase increasing from 157 to >, and hyperglycemia with glucose 400s. she developed respiratory distress around noon. she was transferred to the icu and intubated. she had a severe metabolic acidosis with ph 6.9 and was started on a bicarb drip. her creatinine continued to increase to 2.8 in the icu. her glucose increased to the 600s with evidence of dka, and she was started on an insulin drip. her lactate rose to 9 and she spiked a fever to 106.2. her bp dropped to the 60s systolic, and she was started on norepinephrine. she reportedly received a total of about 6 l of fluids during her osh stay. she was also treated empirically with imipenem for possible necrotizing pancreatitis. . prior to transfer, she was paralyzed for continued ventilation due to being dyssynchronous on the vent and overbreathing. she was on ac with rr 26, peep 5, and fio2 70%. her most recent abg was ph 7.09, pco2 47, and po2 98. she continued on a bicarb drip, insulin drip, and norepinephrine. for access, she had a right subclavian central line. she was transferred to by . on arrival to the icu, she was intubated, sedated, and paralyzed. she was unable to provide any additional history. . review of systems: unable to obtain due to patient intubation and sedation. past medical history: # diabetes mellitus type 2 # hypertension # rheumatoid arthritis # alcohol abuse social history: # tobacco: smokes 1 ppd # alcohol: unclear alcohol consumption, possibly several drinks daily, but could be significantly more # illicits: denies family history: non contributory physical exam: physical exam on admission: vitals: t 41.6, bp 107/63, hr 151, rr 22, spo2 93% on 100% fio2 general: african american female, obese, intubated and sedated heent: sclera anicteric, dry mm, et tube in place neck: jvp not elevated, no lad lungs: clear to auscultation bilaterally on anterior exam cv: regular tachycardia, normal s1 + s2, no murmurs, rubs, gallops abdomen: midline surgical scar, obese, moderately distended, firm but not tense, bowel sounds present gu: foley in place draining cloudy urine ext: cool extremities, 1+ pulses, no clubbing, cyanosis, or edema . ==================================================== . physical exam on discharge: vs 96.5 103 117/72 23 100%ra gen: off trach mask now, appears comfortable, moving around, slightly agitated. cv: tachycardic, holosystolic murmur (not easy to appreciate previously tachycardia, ventilator noise) pulm: lungs clear abd: distension improved, improving, mildly tender, + bs neuro: answers questions, follows simple commands (moves toes, squeezes fingers). moves all 4 extremities to prompting. pertinent results: labs on admission: 09:09pm neuts-63 bands-6* lymphs-26 monos-5 eos-0 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-2* 09:09pm hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-1+ microcyt-occasional polychrom-normal 09:09pm plt smr-normal plt count-153 09:09pm pt-16.1* ptt-36.4* inr(pt)-1.4* 09:09pm fibrinoge-557* 09:09pm triglycer-3950* 09:09pm albumin-2.8* calcium-5.6* phosphate-1.8* magnesium-1.3* 09:09pm ck-mb-7 ctropnt-0.01 09:09pm lipase-2863* 09:09pm alt(sgpt)-202* ast(sgot)-871* ld(ldh)-1630* ck(cpk)-5889* alk phos-80 amylase-589* tot bili-0.6 dir bili-0.5* indir bil-0.1 09:09pm glucose-235* urea n-24* creat-4.6* sodium-145 potassium-4.3 chloride-110* total co2-22 anion gap-17 11:39pm type-art temp-40.2 rates-24/ tidal vol-400 o2-100 po2-121* pco2-90* ph-7.06* total co2-27 base xs--7 aado2-514 req o2-85intubated-intubated vent-controlled 11:52pm calcium-4.6* phosphate-1.9* magnesium-1.1* 11:52pm glucose-448* urea n-23* creat-4.8* sodium-139 potassium-3.8 chloride-101 total co2-25 anion gap-17 . imaging: . cxr portable : 1. central line at the cavoatrial junction. 2. mild pulmonary edema. 3. left-sided pleural effusion with mild-to-moderate atelectasis. . tte : the left atrium is mildly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast (resting injection only). there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 75%). left ventricular contractile function appears dyssynchronous. there is a moderate resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. impression: suboptimal image quality. no gross evidence of intracardiac shunt . cxr : the lungs are low in volume and show bilateral lower lobe opacities. the cardiomediastinal silhouette is not well evaluated. the hilar contours and pleural surfaces are normal. an et tube pushes into the right tracheal side wall. an ng tube terminates with its tip in the stomach. a right ij catheter terminates with its tip in the distal svc. no pneumothorax is present. a left pleural effusion is small. impression: mild bibasilar opacities could represent pneumonia. endotracheal tube terminates with its tip against the right tracheal side wall and may be withdrawn. . kub : portions of the right and left abdomen are not included in the field of view provided. within this limitation, the nasointestinal tube is in postpyloric position. the distal-most portion of the nasointestinal tube noted to be turned on itself within the jejunum with the tip projecting over the expected region of the duodenojejunal junction. a kink is noted. the tube should be pulled back slightly to reposition. . cxr : lines and catheters are in appropriate position. cardiac silhouette, vascularity are normal. there are low lung volumes. there is improving aeration at the left lung base with some residual consolidation or atelectasis. left costophrenic angle is not included so evaluation for pleural fluid suboptimal. right lung remains generally clear. impression: improving aeration at the left lung base. . ct head : there is no acute intracranial hemorrhage, extra-axial collection, or mass effect. the ventricles and sulci are normal in size and configuration. there is periventricular white matter hypodensity, compatible with chronic small vessel ischemia, most prominent adjacent to the frontal of the right lateral ventricle. the evaluation of -white matter differentiation is somewhat limited by patient motion; however, it appears grossly intact without evidence of large territorial infarct. the orbits are unremarkable bilaterally. the soft tissues are normal in appearance. there are air-fluid levels in the bilateral maxillary sinuses with associated mucosal thickening, consistent with an intubated state. there is opacification of multiple ethmoid air cells as well as the sphenoid sinuses. there is no osseous abnormality. impression: 1. motion limited, without acute intracranial process. 2. air-fluid levels within the paranasal sinuses consistent with intubated state. attending note: due to motion, it is difficult to exclude loss of -white matter differentiation. if there is focal neurological deficit and concern for an acute infarct, a repeat ct or mri can help. no hemorrhage. . ct abdomen/pelvis : the lung bases have bilateral atelectasis. the liver is homogeneously fatty. the gallbladder appears to have mild gallbladder wall thickening; however, there are no gallstones identified. the wall thickening is likely secondary to fatty liver and pancreatitis rather than acute cholecystitis. without iv contrast, the evaluation of the kidneys, ureters, spleen, and adrenals is limited; however, with this limitation in mind, these organs are normal. the visualized loops of bowel and colon within the abdomen are unremarkable. there is an ng tube seen extending into the ligament of treitz. there is extensive pancreatitis visualized in the mesentery and the lesser sac. there is free fluid seen within the pelvis. there are multiple diverticula within the colon with no evidence of diverticulitis. impression: 1. extensive pancreatitis whose characterization is limited without the aid of iv contrast. 2. bibasilar atelectasis. 3. fatty liver. 4. free fluid within the pelvis. . ruq us : the liver appears echogenic consistent with fatty infiltration. the main portal vein is patent. pericholecystic fluid and ascites as well as mild gallbladder wall thickening likely reflecting secondary inflammatory changes due to the acute pancreatitis. there is no evidence of acute cholecystitis. no cholelithiasis is noted. the bile duct measures 0.6 cm. the spleen measures 10 cm and is within normal limits. the visualized pancreas appears slightly swollen with peripancreatic inflammatory changes consistent with known diagnosis of pancreatitis. impression: 1. peripancreatic inflammatory changes consistent with known diagnosis of acute pancreatitis. 2. echogenic liver consistent with fatty infiltration. other forms of more advanced liver disease such as hepatic cirrhosis or fibrosis cannot be excluded in this study. 3. pericholecystic fluid and ascites as well as mild gallbladder wall thickening likely reflecting secondary inflammatory changes due to the acute pancreatitis. . cxr : findings: in comparison with the study of , the monitoring and support devices remain in place. minimal opacification persists at the left base consistent with mild atelectasis and probable small effusion . cxr : findings: tip of the endotracheal tube is 2 cm above the carina with neck in the flexed position. though the tip of the left internal jugular line appears to be now more medially placed, it may be an apparent finding due to the rotation of the patient. assessment of the left lower lung is limited because of the multiple external lines and devices obscuring the left lower lung field. overall the findings are unchanged since . both lung volumes remain low. the right lung base atelectasis is stable. there are no newly appearing lung opacities concerning for pneumonic consolidation. . ct sinus/max : findings: the patient is intubated and an ng tube is in place. again noted is opacification of the bilateral sphenoid sinuses. two mucus retention polyps are seen within the left maxillary sinus. opacification is noted in multiple ethmoid air cells. the frontal sinuses are clear. there is no osseous destructive change. the mastoid air cells are opacified bilaterally. the visualized portions of the orbits are unremarkable. there is no soft tissue abnormality. the visualized intracranial structures are unremarkable. impression: opacification of the paranasal sinuses, unchanged when compared with , consistent with intubated state. there is no osseous destructive change to suggest an aggressive sinusitis. . ct abdomen/pelvis/chest : 1. evolving acute pancreatitis with widespread early organization of fluid collections with rim enhancement, primarily retroperitoneal. these may be areas of early organizing extrapancreatic fat necrosis or pseudocysts. however, there is no evidence for parenchymal pancreatic necrosis. 2. delayed contrast excretion by the kidneys bilaterally represents underlying renal dysfunction, consistent with history of hemodialysis. 3. right basilar opacification is most likely related to atelectasis, though superimposed infection is not excluded. 4. sigmoid diverticula, without evidence of diverticulitis . us left sided neck veins : impression: occlusive deep venous thrombosis involving the left internal jugular vein. the proximal aspect of the left internal jugular vein was not visualized secondary to overlying bandages. . cxr : findings: as compared to the previous radiograph, the lungs have improved ventilation. pre-existing opacities in the perihilar and the basal lung zoneshave almost completely resolved. unchanged position of the monitoring andsupport devices. no evidence of pleural effusions. . tte : focused study. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . mri head : 1. multiple flair/t2 hyperintense lesions seen throughout the periventricular and deep subcortical white matter. nonspecific though can represent small vessel ischemic disease or inflammatory/demyelinating disease. 2. opacification of the mastoid air cells bilaterally, could represent fluid within mastoid air cells. . cxr: minimal interval worsening of the right lung base atelectasis, whereas on the left side is unchanged. pleural effusions if any are minimal bilaterally. . cxr: the ng tube is in the stomach, in good position. there is obscuration of the left cp angle, some of which could be due to overlying soft tissues but there is probably also small effusion in that region. the right picc line, tracheostomy, dialysis catheter are unchanged. there are some other areas of streaky atelectasis in the left lower lobe. other than the left lower lobe the lungs are clear. . ct abd/pelvis : 1. persistently extensive peripancreatic stranding with increased amount of ascites pooling in the mesocolon and bilateral paracolic gutters. identification of discrete organized collection is difficult without intravenous contrast. 2. decreased right basilar atelectasis. 3. sigmoid diverticulosis. . . labs on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 03:24 12.3* 3.16* 8.6* 25.6* 81* 27.2 33.6 16.1* 296 basic coagulation (pt, ptt, inr) 15.9* 93.4* 1.4* renal & glucose glucose urean creat na k cl hco3 angap 03:24 1001 103* 7.1* 129*2 4.4 83* 20* 30* enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 03:24 60* 73* 401* 188* 0.9 calcium phos mg 9.9 10.9* 2.8* brief hospital course: primary reason for hospitalization: 51 year old female with history of diabetes mellitus type 2, hypertension, rheumatoid arthritis, and chronic abdominal pain who was transferred from hospital for further management of severe acute pancreatitis, respiratory failure, transaminitis and acute kidney injury. . active diagnoses: # acute pancreatitis: she initially presented to osh with evidence of pancreatitis on labs and imaging and was initially stable. she decompensated overnight with rapid worsening of her pancreatitis and multisystem failure requiring intubation. differential for cause of pancreatitis included etoh abuse and hypertgs (tgs ~4000 on admission, trended down to 1700) although pcp records revealed she does not have a history of hypertriglyceridemia. patient was treated with aggressive fluid resuscitation. antibiotics were deferred given recent studies have demonstrated that this would not be beneficial. several days into the the hospital course, patient developed bladder pressures to the high 20s. general surgery was consulted to discuss the possibility of decompression. surgery stated that decompression would be a futile procedure since bladder pressures would go back up shortly after decompression. another option would be to leave the abdomen open, but this would have a high risk of infection. after discussion with family, decompression was deferred and bladder pressures trended down on their own. since patient remained intubated for a prolonged period of time, she was started on tpn for nutrition. she was then transitioned gradually to tube feeds and tpn was stopped. currently, patient is able to tolerate po and has been eating well the past couple of days. . # hypoxic, hypercarbic respiratory failure: she developed respiratory distress at osh was was intubated in the setting of her multisystem failure. she was dyssynchronous on the vent and neuromuscular blockade was initiated for transport. on arrival here, she was ventilated off paralytics, but had continued difficulty with dyssynchronous respiration and abg showing ph 7.08, pco2 95, and po2 106. neuromuscular blockade was resumed with improvement in her ventilation. patient was sedated with fentanyl and versed. hypercarbia most likely due to hypoventilation and increased co2 production. aa gradient of >500, with pao2:fio2 100-130 suggested ards, which was supported by her cxr. given ards, ventilated by ardsnet protocol with low vt and high peeps. an esophageal balloon was placed to help adjust level of peep. she remained intubated for approximately 2 weeks of her course and ventilatory settings were weaned gradually. with suctioning, patient often became vasovagal with hr decreasing drastically, down to low 60s. given hemodynamic instability with manipulation of airway, patient was taken to the or for tracheostomy placement rather than having this procedure done at bedside. patient tolerated tracheostomy well and within days was weaned off the vent with sats in the high 90s on tracheostomy mask. since then, patient had improved and is satting at 100%ra. her trach tube was downsized to a 6.0 and patient is able to speak and also eat solid foods. she will need to follow up with interventional pulmonology and have the tube removed once she's more healed and stable. . l ij thrombosis: patient's l ij hemodialysis line was thrombosed and she was started on anticoagulation. patient was started on heparin drip and coumadin po as well. she is subtherapeutic on coumadin at this point and will need heparin bridging as well as frequent inr checks to make sure that patient remains therapeutic. she will need anticoagulation for at least 3 more months and will need to be reassessed at that time by her pcp for whether or not she will need to continue more anticoagulation. . # hypotension: was likely due to volume depletion due to third spacing initially, with component of septic shock. volume resuscitated patient aggressively on admission, and she transiently required blood pressure support with norepinephrine. pressors were weaned and discontinued early in the hospital stay. she remained normotensive with heart rates ranging from 90s to 120 sinus rhythm. . # acute kidney injury: her creatinine was 0.3 on osh presentation, but acutely rose to 2.0 and then 2.8 prior to transfer. on arrival, her creatinine was 4.6 and rose to 5.5 by the morning. patinet had pre-renal which quickly progressed to atn. she was anuric during the first 2 weeks of admission. patient was initially started on cvvh and then transitioned to hd. all medications were renally dosed. she gradually began to have some urine output, though minimal, approx 10cc/hr. plans for long term hd were discussed with family who agreed. plan for m/w/f hemodialysis. . #transaminitis: patient p/w transaminitis and elevation of lfts to the 1000s. this was thought to be secondary to volume depletion/septic shock and hypoperfusion. with hydration and resolution of septic shock, lfts trended down gradually but did not fully normalize. ck halfway through the hospital course returned at , raising concern for rhabdo contributing to the elevated lft picture. this was treated with continued cvvh and then hd. ck's trended down and on last check was 285. on discharge, lfts were stable an notatble for mild transaminitis (ast/alt 60-70s) and elevated alk phos (188). would recommend continuing to following this several times weekly at discharge. . #hyperglycemia: patient was hyperglycemic on admission with fsbg up to high 400s. this was secondary to underlying dm ii as well as severe pancreatitis and inability of pancreas to produce insulin. initially, patient was on insulin gtt but eventually the gtt was stopped and she was on an insulin sliding scale for glucose control. she should be continued on sliding scale per protocol, which is attached. . #ventilator associated pneumonia: patient had 2 bouts of ventilator associated pneumonia. during the first episode, sputum culture grew out pan sensitive klebsiella and was treated with first cefepime/vancomycin and then just ceftriaxone once sensitivities of sputum cultures were known. second time, vpa based on chest x ray and was treated with vancomycin/cefepime/ciprofloxacin for 8 days, which she has completed. . #anemia: patient had periodically low hct likely in the setting of sepsis as well as exacerbated by renal failure and necessity of frequent blood draws. patient was transfused with prbcs periodically throughout admission, less frequently towards end of admission. her hematocrit remains in the mid 20's at this point and today was 25. . #positive line tip cultures: patient had coagulase negative streptococcus grow out from a line tip and lij cvl tip. however, she never had positive blood cultures and thus was not bacteremic. based on these cultures, vancomycin started for vap was continued to complete a 14 day course of treatment. . # hyperthermia: she had extreme fever to 106.9 on arrival and was treated with tylenol iv and cooling blankets. fever thought to be inflammation from pancreatitis and trended down with initiation of cvvh (see above). patient did have several infections throughout hospital course including 2 bouts of ventilator associated pneumonia, and coag negative staph on blood cultures from a-line on and ij tip catheter on . toward the end of the patient's hospitalization, fever curve was improving and the patient was afebrile at the time of discharge. . #hyponatremia: her sodium was trending down at discharge from 132 to 129. would recommend following this closely and checking urine lytes. . #agitation: she was started on started on olanzapine 5mg with improvement in agitated delirium. medications on admission: home medications: hydrochlorothiazide 25 mg po daily cyclobenzaprine 10 mg po qhs nabumetone 750 mg po bid metoprolol succinate 100 mg po daily amlodipine 5 mg po daily fluticasone 50 mcg nasal spray transfer medications: imipenem 250 mg iv q6h (last dose 8/4 1846) amlodipine 5 mg po daily ( 0817) metoprolol 50mg po bid ( 1000 not given) acetaminophen 1000 mg once ( 1743) insulin gtt 4 units/hr midazolam gtt fentanyl gtt morphine 2 mg ( 0136) dilaudid 0.5-2 mg ( 1149) zofran 4 mg iv q6h prn nausea heparin 5000 units sc q8h ( 1850 not given) pantoprazole 40 mg iv q12h ( 0814) calcium gluconate ( 1619 and 1754) . allergies: nkda discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 2. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for firm stools: please hold for loose stools. 3. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for wheeze. 5. aluminum hydroxide gel 600 mg/5 ml suspension sig: ten (10) ml po q6h (every 6 hours). 6. b-complex with vitamin c tablet sig: one (1) tablet po daily (daily). 7. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 9. insulin lispro 100 unit/ml solution sig: per ss units subcutaneous four times a day: please administer via insulin sliding scale; please see attached; may not need as patient improves clinically. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. heparin (porcine) in ns 10,000 unit/1,000 ml parenteral solution sig: as directed, per protocol, to titrate of ptt 60-80 intravenous per protocol, please see attached.: please see attached protocol; until therapeutic inr reached. discharge disposition: extended care facility: - discharge diagnosis: pancreatitis respiratory failure acute renal failure rhabdomyolysis ventilator associated pneumonia discharge condition: mental status: confused - always. level of consciousness: lethargic and not arousable. activity status: bedbound. discharge instructions: dear ms. , it was a pleasure taking care of you at the . you were admitted for pancreatitis, a severe infection of your pancreas, likely a result from alcohol abuse. should you continue to abuse alcohol, this infection is likely to recur. the pancreatitis was so severe that it led to many other complications such as acute renal failure, muscle breakdown, respiratory failure leading to having a machine help you breathe, and pneumonia. you had made remarkable improvement with all of these complications and are now doing quite well. you continue to have a tracheostomy tube down your throat and will need to have that removed in the near future. in the mean time, you will be going to rehabilitation center to regain your strength. you will also continue to have outpatient dialysis three times a week until your kidney functions returns to baseline. . during your stay, we found that you developed a blood clot in your neck, for which you are to use a blood thinner, coumadin. this medication requires frequent monitoring (blood tests) to make sure that the dose you are taking are rendering the desired effects. it is very important that you have this monitored by your pcp. . we wish you a speedy recovery and hope that you are able to return home soon. followup instructions: please follow up with your pcp (dr. , d. ) in 1 week following your rehab stay. the rehab should help you coordinate an appointment. name: , : internal medicine location: health center address: , , phone: **please discuss with the staff at the facility the need for a follow up appointment with your pcp when you are ready for discharge** name: , md location: - division of pulmonary medicine address: , 116, , phone: **we are working on a follow up appointment with dr. within 1 week. if you have not heard from the office within 2 days or have any questions, please call the number above.** procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis temporary tracheostomy diagnoses: acidosis hyperpotassemia thrombocytopenia, unspecified anemia in chronic kidney disease hypocalcemia end stage renal disease tobacco use disorder acute kidney failure with lesion of tubular necrosis friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver hyposmolality and/or hyponatremia unspecified acquired hypothyroidism pure hyperglyceridemia acute and chronic respiratory failure other shock without mention of trauma long-term (current) use of insulin pressure ulcer, lower back rheumatoid arthritis other encephalopathy kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure obesity, unspecified ventilator associated pneumonia systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction other complications due to renal dialysis device, implant, and graft rhabdomyolysis acute pancreatitis other and unspecified alcohol dependence, continuous pressure ulcer, stage ii nontraumatic compartment syndrome of abdomen acute venous embolism and thrombosis of internal jugular veins 

Answer: The patient is high likely exposed to