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: patient is a 51-year-old female with no significant past medical history transferred from an outside hospital with diabetic ketoacidosis. patient had had approximately two-month history of polyuria, polydipsia, and weight loss, and two days prior to presentation developed a sore throat with subsequent abdominal pain, nausea, and vomiting. she had had no fever, chills, chest pain, shortness of breath, or diarrhea. patient had had unintentional weight loss of 20 pounds over the last two months. patient presented to hospital in where she was initially found to have a white blood count of 29.7 with 93% polys, 1% bands. she had a glucose of 677, an anion gap of 29 with negative enzymes. her ph was 6.98, her bicarbonate 8, and her oxygen 138. secondary to lack of intensive care unit beds in , she was transferred to for further evaluation and treatment. prior to being transferred she was treated with bicarbonate, insulin, intravenous fluids, and a gram of ceftriaxone at . on arrival to the emergency department the patient was found to have an anion gap of 28, a delta delta of around 1, a potassium of 3.1, a glucose of 362, phosphorous of 0.8, and arterial blood gases that showed a ph of 7.23, a bicarbonate of 15. in the emergency department she was continued on aggressive intravenous fluids and insulin drip. she was also found to have an exquisitely tender abdomen most significantly in the right lower quadrant. she also had large red blood cells in her urine. in the emergency department she was also evaluated with ct scan of the thorax. following initial evaluation and resuscitation in the emergency department, the patient was transferred to the medical intensive care unit for further management and treatment. past medical history: 1. anxiety disorder. 2. hypothyroidism. 3. anemia that has been attributed to iron deficiency in the setting of heavy menstrual periods. social history: patient denies any alcohol or tobacco use. she lives with her mother in and is currently unemployed. family history: there is no family history of diabetes, cardiovascular disease, or cancer. allergies: patient has no known drug allergies. medications on admission: 1. synthroid 75 mcg q. day. 2. xanax 1 mg t.i.d. p.r.n. anxiety. 3. iron supplement. physical examination: on initial examination patient's temperature is 97.4 degrees, blood pressure 105/45, heart rate in the 110s, respiratory rate of 24, oxygen saturation 100% on room air. in general, this is a thin, middle-aged woman in some distress. heent exam shows mucous membranes to be slightly dry. neck veins are flat. there is no cervical lymphadenopathy. the oropharynx is clear. chest exam shows lungs to be clear to auscultation bilaterally. heart is tachycardiac. on abdominal exam patient's abdomen is soft but diffusely tender. there is no rebound or guard. examination of the extremities shows palpable pulses throughout; no cords, clubbing, or edema. the patient is alert and oriented times three and moving all four extremities. laboratory data: cbc shows white count of 26.9, hematocrit of 36.2, platelets of 237. chem-10 showed sodium of 150, potassium of 2.9, chloride of 121, bicarbonate of 13, bun of 21, creatinine of 0.9, and glucose of 94. calcium was 8.1, phosphorous 0.5, magnesium 1.7. the anion gap was 16. the patient had a ck of 778, mb of 10, and index of 1.3. ldh was 164 and lipase was 17. patient had an ekg which showed sinus tachycardia with normal intervals and axis. there were no st elevations or t-wave changes. chest x-ray showed no pneumonia but a nodule in the right lower lobe. ct scan of the chest showed abnormal mediastinal and paratracheal density with question for nodes versus neoplasm versus infection versus attempted line placement from outside hospital. bilateral pleural effusions were also noted. the chest x-ray was noncontrast, and a follow-up contrast study was recommended. abdomen and pelvis ct showed a fibroid uterus and bilateral lower lobe pleural-based nodular opacities which were thought to be nonspecific. hospital course: 1. intensive care unit course: patient was admitted to the medical intensive care unit for further treatment of her diabetic ketoacidosis. she was treated with intravenous fluids, an insulin drip, and aggressive electrolyte monitoring and repletion. the general surgery service followed her abdominal pain which subsequently resolved during her stay in the icu. the surgical service signed off on her abdominal pain, and it was attributed to pain secondary to dka versus pain around the time of her menstrual period. patient was transitioned to humalog sliding scale and, when taking adequate p.o. intake, was also treated with lantus insulin at night. over the course of her icu stay the patient also had rising cks into the 850s which was thought to be secondary to hypophosphatemia. she was treated with aggressive hydration, as well, for this rising ck. over the course of her stay in the icu patient's electrolytes normalized and her anion gap closed, she began to feel well, and was without symptoms. when she had stabilized she was transferred to the floor for further diabetic teaching and monitoring. 2. diabetic ketoacidosis: the etiology of patient's dka was not entirely certain. she had no ekg changes, and no certain source of infection was identified. however, she did have a sore throat prior to her presentation with dka. it was thought that this was possible etiology. 3. diabetes mellitus: on the floor patient was managed with h.s. lantus and a humalog sliding scale. she was followed by the consult service as well as the nutrition service. nursing staff also engaged in teaching patient about diabetes. on discharge the patient had follow up arranged with nutritionist, educators, and diabetologists at the clinic. at the time of this dictation patient had a hemoglobin a1c that came back at a level of 12.8. she also had an eyelet cell antibody which was pending at the time of this dictation as well as a c. peptide that was pending at the time of this dictation. 4. neuro: patient was maintained on her benzodiazepine regimen for her anxiety. 5. chest: patient had abnormal findings on chest ct. please see the online dictation for full details. at time of discharge patient was scheduled for a follow-up contrast ct of her chest to further investigate these findings. 6. cardiovascular: the patient's heart rate was in the 100s throughout her hospital stay. she reported that this may have been chronic and that a primary care physician in the past had told her that she was tachycardiac. it was thought that her tachycardia could be secondary perhaps to her anxiety versus anemia versus her synthroid dosing. therefore, her synthroid was decreased from 75 to 50 mcg per day. patient will follow this dosing up with her primary care physician. 7. abdomen: patient's abdominal pain resolved during her time in the icu. her abdomen was benign at the time of discharge. 8. extremities: the patient had bilateral lower extremity edema probably secondary to the fluid load given her aggressive hydration. this edema decreased as the patient self-diuresed. 9. infectious diseases: patient had low-grade temperatures throughout her admission. her white blood count trended down and was within normal limits at the time of her discharge. no infectious process was identified. blood cultures were pending at the time of this dictation, and urine cultures were negative. 10. anemia: the patient stated that her anemia was at baseline. iron studies were sent and were not thought to be consistent with an iron-deficiency anemia with an iron of 49, a tibc of 143, a ferritin of 154, and a transferrin of 110. it is possible that these numbers are consistent with anemia of hypothyroidism or anemia of some other chronic disease. patient will follow up with her primary care physician regarding her anemia. 11. endocrine: thyroid studies were sent and tsh was found to be 0.15, free t4 1.3, and t3 66. it is difficult to interpret these findings in the acute setting, but the patient's synthroid dose was decreased to 50 mcg and she was instructed to follow up with her primary care physician and have repeat thyroid function tests within six weeks. at the time of her discharge patient was feeling well and approaching her baseline, although she was somewhat anxious about her diabetic teaching. however, she was provided with all resources in order to manage her diabetes and set up for vna visits during the first few days at home to help her with her diabetic regimen. follow-up appointments were arranged with clinicians, nutritionists, and educators and recommended with her primary care physician. she had a ct scan with contrast that is currently scheduled in the system. discharge medications: 1. alprazolam 1 mg t.i.d. 2. levothyroxine 50 mcg q. day. 3. iron supplement. 4. lantus 8 units q. h.s. 5. humalog sliding scale. disposition: discharged to home with vna services for three days. discharge status: patient was asymptomatic at time of discharge and was comfortable with her diabetic teaching. discharge diagnoses: 1. diabetic ketoacidosis. 2. insulin-dependent diabetes mellitus. 3. anxiety disorder. 4. hypothyroidism. 5. anemia. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnoses: acidosis anemia, unspecified unspecified acquired hypothyroidism diabetes with ketoacidosis, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to