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: vicodin / ms contin attending: chief complaint: hypotension major surgical or invasive procedure: none history of present illness: patient is a 64 year old man with a history of cad, copd, chf, diabetes, and hypertension who presented to the ed from with ectopy during a sleep apnea test. on the night prior to admission the patient had a sleep study done at which showed frequent svt. he also complained of itching during the study. he was transfered to the ed there where an ecg showed nsr at a rate of 61 with q in iii, avf but no other abnormalities. bp was 124/79. patient had a bladder scan that showed 550 cc of urine but he refused a urinary catheter. patient requested transfer to . . at the ed bp was 106/50, hr 65, rr 16, o2 94% ra, t 97.3. he was given his am meds which included isosorbide mononitrate 60 mg, finasteride 5 mg, lisinopril 5 mg, metoprolol xl 25 mg, and aspirin 325 mg. at 3 pm his bp was noted to be 73/58. he denied dizziness, shortness of breath, chest pain. he received 500 ml of ns with no change in bp. at 4:30 bp was 101/49, but at 7:30 bp was 90/69 and patient was somnolent. he received another 700 cc of ns and bp was 80/58. . ros: positive for vision changes, headaches. negative for fevers, chills, sweats, nausea, vomiting, shortness of breath, chest pain, dysuria, abdominal pain, diarrhea, black or bloody stools. past medical history: 1) chf, ef 45% from most recent echo , mixed lv systolic and diastolic dysfunction, cardiomyopathy 2) cad, nstemi in during admission for urosepsis with hypotension and coma. 3) type ii dm c/b neuropathy, nephropathy, per pt no retinopathy 4) htn 5) cri, baseline creatinine of 1.7 6) anemia of chronic disease. 7) sleep apnea on bipap, currently 8) chronic restrictive ventilatory disease secondary to a bile duct leak with pulmonary fibrosis requiring decortication 9) neuropathy - hands and feet 10) lower extremity claudication 11) bph. 12) glaucoma; on carbonic anhydrase inhibitor 13) bilateral cataracts s/p surgical removal 14) depression 15) osteoarthritis 16) erectile dyscunction s/p penile implant .. past surgical history: 1) roux-en-y reconstruction after laparoscopic cholecystectomy c/b damage to cbd 2) decortication for fibrothorax complicated by respiratory failure requiring tracheostomy. 3) appendectomy. 4) left knee/hip replacement social history: the patient lives with his wife. does not smoke. only minimal ethanol. otherwise, he is extremely sedentary. family history: cva - brother breast - mother emphysema - father physical exam: vs: t 96.8 hr 63 bp 103/50 rr 15 o2 sat 87-96% 2l gen: well appearing, comfortable, lying in bed in nad. slightly somnolent but arousable and oriented x 3. heent: perrl, eomi, sclera anicteric, mmm. neck: no lad, or thyromegly. jvp at 10 cm. cv: rrr with no m/r/g lungs: decreased bs bilaterally with expiratory wheezes. abd: soft, nt, nd active bs, no hepatosplenomegly. ext: cool with 1+ dp pulses. no clubbing, cyanosis or edema pertinent results: 08:00am plt count-133* 08:00am neuts-70.4* lymphs-20.0 monos-4.1 eos-4.6* basos-0.8 08:00am calcium-8.4 phosphate-6.4*# magnesium-2.6 08:00am wbc-6.7 rbc-3.89* hgb-12.2* hct-34.8* mcv-90 mch-31.4 mchc-35.1* rdw-13.9 08:00am ctropnt-0.10* 08:00am ck(cpk)-257* 08:00am glucose-185* urea n-63* creat-3.0* sodium-138 potassium-5.0 chloride-99 total co2-27 anion gap-17 04:20pm ck-mb-4 04:20pm ctropnt-0.11* 04:20pm ck(cpk)-275* 10:45pm plt count-148* 10:45pm wbc-12.2*# rbc-3.76* hgb-11.9* hct-34.0* mcv-91 mch-31.6 mchc-34.8 rdw-14.1 10:45pm calcium-7.7* phosphate-8.8*# magnesium-2.6 . blood cultures remained negative . cxr : unchanged appearance of the chest without evidence of acute cardiopulmonary disease. . ecg: nsr at 60 bpm with normal intervals. normal axis. q in iii and avf. biphasic tw in iii. no change from prior. . renal us: 1. no hydronephrosis. 2. renal size asymmetry is stable, but raises the possibility of underlying renal artery stenosis and clinical correlation is suggested. 2. splenomegaly. brief hospital course: 64 year old man with chf, crf (baseline cr 1.7), cad and copd who presents from ed after developing asymptomatic hypotension and acute on chronic renal failure after taking his blood pressure medications. . chronic pain: mr. suffers from chronic pain in his left hip s/p hip replacement () and pain in his left shoulder secondary to bursitis. he had previously been treated at the center () for left hip pain. after four doses of ms contin, he developed lethargy and hypotension and was referred to the emergency department. ms contin was believed to cause the itching present on presentation in addition to possibly contributing to his hypotension. it was also felt that his blood pressure medications had been given all together and this compounded his drop in blood pressure. due to the potential for ms contin misuse in addition to the above concerns, he was changed to percocet for pain control. the pain service was consulted who recommended topiramate which was started on . he will follow up with the pain center as an outpatient and will continue with mind body program. . arf on ckd: on admission, the patient's creatinine had peaked at 4.0 before normalizing. he was noted to be in non-oliguric acute renal failure. the patient was given ivf with resolution of arf; his creatinine returned to baseline 1.4. as his creatinine responded to fluids, the renal team felt that the etiology of his renal failure was pre-renal. renal us showed asymmetric sized kidneys. he will follow up with dr. as outpt. pt voided well after foley d/c. . hypotension: mr. presented with persistent hypotension despite boluses of ns in the ed. after work-up in micu, the differential was narrowed to include hypotension from dehydration vs. med related hypotension. he was able to regain a normal blood pressure holding his bp meds for short period of time. fluids were also administered. a renal us was done on admission to evaluate cause of arf which showed that the patient had asymmetric sized kidneys and raised the possibility of renal artery stenosis in the setting of starting an ace-i. the ace-i had been stopped on admission due to hypotension, but the renal team felt that the patient could be restarted on a low dose . once his blood pressure stabilized, losartan and metoprol were restarted. he was kept even fluid-wise. . osa: mr. had a sleep study done which reaffirmed complex sleep-disordered breathing with partially successful titration study. they recommended home therapy at bipap 16/13 with 100 ml of dead space and 4 liters of o2. . dm: while in the hospital he was kept on a riss and was followed by . . htn: once his blood pressure stabilized he was put back on losartan and metoprolol. lisinopril and imdur were held. . bph: he was continued on flomax and proscar. . anemia: the patient's hematocrit ranged between 32-34 which appears to be his baseline. fe studies in were consistent with acd. we recommend that the patient undergo outpatient evaluation by hematology for chronically low hematocrit. . cad: he did have one episode of epigastric abdominal discomfort while in hospital for which he had serial ekgs and serial enzymes, which did not show any evidence of an ongoing acute coronary syndrome. he was continued on asa but imdur was held given recent hypotension. . diastolic dysfunction: mr. had a recent echo on which showed an ef of 65%. his is/os and weights were closely monitored and he remained asymptomatic from this perspective. . depression: he was maintained on lexapro for depression. . fen: maintained on a cardiac and diabetic diet and electrolytes were repleted prn. . code: full code medications on admission: escitalopram 5 mg qam, 10 mg qhs calcium carbonate 500 mg qam lasix 60 mg daily aspirin ec 325 mg daily colace 100 tamsulosin sr 0.8 mg daily isosorbide mononitrate sr 60 mg daily finasteride 5 mg daily calcitriol 0.25 micrograms daily lisinopril 5 mg daily toprol 25 mg daily protonix 40 mg oxycodone prn lantus 11 units qhs regular insulin sliding scale oxycontin 15 mg prn discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. escitalopram 10 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 3. escitalopram 10 mg tablet sig: 0.5 tablet po qam (once a day (in the morning)). 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qam (once a day (in the morning)). 5. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 6. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 7. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. disp:*1 bottle* refills:*1* 9. toprol xl 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 10. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po daily (daily). 11. topiramate 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). disp:*30 tablet(s)* refills:*0* 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. losartan 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 15. insulin glargine 100 unit/ml solution sig: seven (7) units subcutaneous at bedtime. disp:*30 units* refills:*2* 16. insulin regular human 300 unit/3 ml insulin pen sig: asdir per sliding scale subcutaneous four times a day: per sliding scale. disp:*qs * refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: hypotension acute renal failure urinary retention chronic hip and shoulder pain -------------- chf cad type ii dm htn anemia of chronic disease. sleep apnea on bipap, currently discharge condition: stable. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction please take all medications as prescribed. please do not continue to take lisinopril. we started you on losartan 50mg instead. you are now taking isosorbide mononitrate 30mg, not 60mg. you have been started on topiramate 25mg to take at bedtime, for pain. if you start to feel lightheaded or dizzy, please your md. followup instructions: please follow up with dr. 1-2 weeks after discharge. please follow up with pain center. please continue to attend the mind body program. please follow up with dr. after discharge. procedure: insertion of indwelling urinary catheter diagnoses: hyperpotassemia anemia of other chronic disease obstructive sleep apnea (adult)(pediatric) esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes unspecified glaucoma depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) hypotension, unspecified long-term (current) use of insulin old myocardial infarction postinflammatory pulmonary fibrosis osteoarthrosis, unspecified whether generalized or localized, site unspecified pain in joint, pelvic region and thigh dehydration hip joint replacement pain in joint, shoulder region unspecified drug or medicinal substance causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to