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: sulfa (sulfonamide antibiotics) attending: chief complaint: hypotension major surgical or invasive procedure: right picc insertion ir guided drainage of large abdominal hematoma angiography of the celiac artery, sma, gda, and abdominal aorta left internal jugular central line insertion arterial line placement history of present illness: this is a 77 year old male with pmh of multiple myeloma s/p 11 months of chemotherapy through , rcc s/p left nephrectomy, cki newly started on hd m/w/f as of 2 weeks ago, dm2 c/b gastroparesis/peripheral neuropathy, htn, and cad being transferred from with altered mental status, afib with rvr, hypotension requiring neosynephrine drip, and for ir embolization for what was thought to be a large fluid collection in his abdomen representing an actively extravasating hemorrhagic right renal cyst. his current medical issues all seemed to start with several falls starting about a month ago when one of his outpatient doctors started on a new diuretic regimen which made him lose 40lbs in 2 weeks and threw off all of his electroyltes. after one of these falls, he was most hospitalized at from to for a syncope work-up. he also was found to have epigastric pain with coffee-ground vomiting at that time. per osh records, a ct abdomen revealed a hemorrhagic cyst of the liver vs. a right renal hemorrhagic cyst but no management of this fluid collection was initiated at the time. the patient was transferred to following transfusion of 3 units of prbcs, dialysis, and treatment with epogen. this morning, he began complaining of intensifying abdominal pain and the rehab staff noted pallor on physical exam. he also developed altered mental status and ems was called. he was found to be hypotensive to the 50s, diaphoretic, and pale; but was mentating according to report. he was transported back to where his hematocrit was found to be 24 and a ct abdomen/pelvis was performed that showed marked interval enlargement of what was read as an exophytic right renal cyst with concern for active hemorrhage. he was also noted to be in afib with rvr to the 120s-130s and a diltiazem drip was started. a neosynephrine drip was also started for hypotension and he was given 3l of ns. he was then sent in an ambulance to on a neo drip and dropped his sbp to the 80s transiently which responded to 110s systolic after a 1l ns bolus. . in the ed, initial vs were t=97.4, hr=120, bp=116/64, rr=16, pox=100% on nrb. he was noted to be in afib with rvr in the 120s despite a diltiazem drip started at osh when he arrived with a sbp in the 110s on a low dose of neosynephrine drip. on physical exam he was noted to have a large, tender mass on the right side of his abdomen. general surgery, urology, and ir were all consulted. his osh scans were reviewed and on preliminary read it looked as though he had a chronic free standing fluid collection with subacute blood in it, but no active extravasation. it was unclear if the fluid collection was originating from the pancreas or the gastroduodenal artery. there was also a separate right renal/adrenal cyst noted. ir decided to take the patient for an aortogram to see if there was any active bleeding that could be embolized. he was also noted on cxr to have a rll infiltrate concerning for pna and was given a dose of vancomycin and ceftriaxone in the ed. the diltiazem drip was also stopped and his hr remained in the 120s. the ed also tried to shut off the neosynephrine drip, but his sbps fell to the 90s and it was turned back on prior to going to ir for his procedure. he also got 2 units of prbcs for a hematocrit of 26.6 with an unknown baseline. a left ij triple lumen was also placed for access in the ed and blood cultures were sent. . in the ir suite, the fluid collection was felt to be a pancreatic pseudocyst. arteriograms of the aorta, celiac, and sma systems revealed no active extravasation or bleeding. the fluid from this collection was not sampled. . in the icu, initial vs were temp: 97.2, bp: 122/57, hr: 69 rr: 21, and o2sat: 98% on nc. the patient's main complaint was back pain which he has chronically and was exacerbated from laying still after his ir procedure. besides the pain the patient was feeling much better and was no longer confused. he mentions that he was being treated for a pna found on cxr at his rehab since . otherwise, he denied any shortness of breath, cough, fevers, chills, headache, or chest pain. he does report having recent difficulty focusing his vision, new onset palpitations earlier today which have since resolved, and constipation. he also reports right sided abdominal pain which has become less severe and increasing edema. past medical history: pmh - plasma cell dyscrasia igm - not myeloma but ? wadenstrom's variant s/p 11 months melphalan and prednisone (last chemo ) -renal cell carcinoma s/p left nephrectomy in -dm2 -peripheral neuropathy -gastroparesis -esrd on hd m/w/f -htn -cad with mild, nonobstructive lesions seen on cath in -hyperlipidemia -bph -gout -hypothyroidism -gerd . past surgical history: -rcc s/p l nephrectomy in -s/p splenectomy for itp -hernia repair social history: the patient lived at home with his son, , up until this most recent hospitalization at the osh when he was started on hd and discharged to rehab. he has 2 sons and 1 daughter. remains independent in his adls and this is his first admission to a rehab facility. he is widowed and his wife passed away in . he is a retired clerical worker for the irs. he currently denies smoking, but does have a history of cigar smoking for approximately 40 years. he reports no etoh or illicit drug history. he mobilises independently and has an et of 20yrds. family history: his father died of lung cancer at 81 and his mother died at 90. his brother died of lung cancer. uncles with dm2, gout. physical exam: admission vs: temp: 97.2, bp: 122/57, hr: 69 rr: 21, o2sat: 98% on nc gen: pleasant, comfortable elderly male in nad heent: perrl, eomi, anicteric, dry mm neck: supple, left ij in place c/d/i resp: coarse breath sounds anteriorly on the right, but with good air movement throughout and no wheezing cv: rrr, 2/6 sem noted abd: soft with large, firm, tender right sided mass palpated. bs+. ext: 3+ edema bilaterally, palpable pulses, right sided groin ir cath site c/d/i with no hematoma or bruit skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. . discharge vs: temp: 98.8, bp: 145/86, hr: 79 rr: 18, o2sat: 97% ra gen: pleasant, comfortable elderly male in nad. r tunnelled dialysis cath heent: perrl, eomi, anicteric, mmm. loose tooth upper left incisor m1 tooth medial to left canine. anisocoria left pupil larger than right r=3mm+ l=4mm + neck: supple resp: decreased breath sounds both bases no crackles cv: rrr, esm noted. jvp not elevated. abd: soft with large, firm, tender right sided mass palpated. bs+. ext: 2+ edema bilaterally to knees - much improved, palpable pulses, calves snt skin: no rashes/no jaundice/no splinters neuro: aaox3. gcs 15/15. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. pertinent results: admission labs 05:35pm blood wbc-5.5 rbc-2.52* hgb-8.2* hct-26.6* mcv-106* mch-32.8* mchc-30.9* rdw-20.0* plt ct-104* . other labs 08:00am blood ret man-6.8* 12:29am blood ck(cpk)-41* 08:26am blood ck(cpk)-40* 11:59am blood ld(ldh)-995* 05:35pm blood lipase-41 05:35pm blood ctropnt-0.10* 12:29am blood ctropnt-0.13* 08:26am blood ctropnt-0.14* 05:59pm blood ck-mb-2 ctropnt-0.17* 06:21am blood ck-mb-2 ctropnt-0.17* 11:59am blood hapto-154 08:00am blood vitb12-687 folate-18.0 10:44am blood triglyc-124 hdl-24 chol/hd-3.4 ldlcalc-33 08:00am blood tsh-17* 08:00am blood free t4-0.91* 04:57am blood cortsol-21.7* 04:57am blood cortsol-31.6* . discharge labs 05:54am blood wbc-7.2 rbc-2.70* hgb-8.7* hct-28.6* mcv-106* mch-32.3 mchc-30.4* rdw-24.1* plt ct-69* 06:45am blood pt-13.3 inr(pt)-1.1 05:54am blood glucose-86 urean-17* creat-3.8*# na-140 k-4.1 cl-101 hco3-32* angap-11 06:45am blood alt-11 ast-18 alkphos-93 totbili-0.4 . abdominal cystic fluid 01:07pm ascites wbc-* hct,fl-26* polys-99* lymphs-0 monos-1* 01:07pm ascites totpro-6.6 amylase-0 lipase-29 1:07 pm peritoneal fluid gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen, cx negative for growth . 10:45 am fluid,other site: hematoma gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth . . microbiology: bc and 2x -ve ucx and -ve left ij cvc tip -ve . . radiology. ct abdomen w/o contrast study date of 6:05 pm impression: 1. massive complex cystic lesion in the right hemiabdomen with internal hyperdensity suggestive of hemorrhagic components, with limited assessment of internal enhancement. this lesion appears separate from the right kidney and liver, and while closely associated with the pancreatic head, appears to remain separate as well from the pancreas. no active extravasation. this lesion may represent a hematoma, possibly from trauma. 2. large right adrenal myelolipoma. 3. status post left nephrectomy without evidence of local disease recurrence. status post splenectomy. 4. right middle lobe ground-glass nodules measuring up to 8 mm, possibly infectious or inflammatory in etiology. recommend followup in three months to document stability especially in a patient with known primary malignancy. 6. moderate bilateral pleural effusions with compressive atelectasis. 7. multiple right renal cysts, some of which hyperdense and some minimally complex. 8. diffuse atherosclerotic disease. 9. mild-to-moderate anasarca. 10. moderate pericardial effusion. 11. cholelithiasis. . angiography of the celiac artery, sma, gda, and abdominal aorta 7:10 pm findings: 1. conventional arterial anatomy. 2. there is displacement of the gda and sma vessels medially and inferiorly, corresponding to ct findings of a large cystic mass. no focal arterial extravasation or pseudoaneurysm is identified. additionally, tiny vessels from the gda distribution appear to extend inferiorly along the wall of this cystic mass. 3. the abdominal aortogram demonstrated no evidence of extravasation. impression: no evidence of active extravasation or pseudoaneurysm . u/s guided drain placement of hematoma 9:51 am impression: technically successful aspiration and drainage (8f navare catheter) of right abdominal collection with imaging and gross findings representing a hematoma. specimen sent to microbiology for further analysis immediately following the procedure . xr chest (portable ap) study date of 2:40 am findings: in comparison with study of , the catheters remain in position. continued enlargement of the cardiac silhouette with increasing pulmonary vascular congestion. bibasilar opacifications are consistent with atelectasis and pleural effusions . cta abdomen/pelvis w&w/o c & recons study date of 5:22 pm impression: 1. interval decrease in size of right abdominal hematoma with drainage catheter in place. the hematoma now measures 14 x 12 cm (previously 17 x 15 cm). no evidence of active extravasation. 2. cholelithiasis and vicarious contrast excretion within the gallbladder. 3. stable appearance of right kidney with multiple simple and slightly complex cysts. 4. large right adrenal myelolipoma. 5. status post left nephrectomy with no evidence of local disease recurrence. status post splenectomy. 6. moderate bilateral pleural effusions, moderate anasarca, and moderate pericardial effusion, all unchanged. 7. diffuse atherosclerotic disease. . xr chest (portable ap) study date of 11:28 am findings: in comparison with the study of , the cardiac silhouette remains enlarged, though there is no evidence of vascular congestion or the diffuse opacification previously seen on the right. there is continued opacification at the left base with silhouetting of the hemidiaphragm, most likely consistent with volume loss in the left lower lobe and small effusion. no evidence of acute focal pneumonia. dialysis catheter and picc line remain in place. . portable tte (complete) done at 2:30:00 pm the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is a moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. . tte (focused views) done at 3:08:22 pm left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are structurally normal. there is a small to moderate sized circumferential pericardial effusion most prominent (1.3cm) around the apex of the right and left ventricle and relatively little inferolateral (<0.5cm) to the left ventricle. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the findings are similar. . pathology . cytology report peritoneal fluid procedure date of diagnosis: peritoneal fluid: negative for malignant cells. inflammatory cells, mostly neutrophils. blood. . brief hospital course: 77 year old male with pmh of plasma cell dyscrasia s/p 11 months of melphalan and prednisone through rcc s/p left nephrectomy, esrd recently started on hd, dm and htn who was admitted with hypotension, rapid af and confusion for possible ir embolisation of what was thought to be a large intra-abd hematoma with concern for ongoing hemorrhage. . # large intra-abdominal hematoma: pt was transferred from an osh due to concern for possible enlarging hemorrhagic renal cyst. however, the fluid collection was felt to be separate from both the kidney and pancreas. pt had required blood transfusions prior to transfer and was hypotensive with a pressor requirement on arrival to . repeat ct abdomen without contrast on demonstrated the large hematoma which was causing ivc compression and was felt possibly secondary to trauma. surgery and ir were consulted and this was felt possibly due to duodenal hemorrhage. pt underwent angiograms of the aorta, celiac, and sma on which did not showed any evidence of extravasation or pseudoaneurysm. the hematoma was drained on by ir and put out 750cc. bp improved after drainage and pt was able to weaned off pressor support in the following days. peritoneal fluid results showed wbc: 99% polys, hct: 26, amylase 0. both cultures and cytology returned negative. pt had considerable abdominal pain at the drain site which improved with iv dilaudid. he was transferred from the icu to the general medical on . pt had a repeat cta abd and pelvis on which showed an interval decrease in size but still a large residual hematoma with no blush to suggest active bleeding. his hb/hct remained stable and abdominal pain improved significantly. he will be followed by general surgery in their clinic on . his case was frequently discussed with ir and drain continued to have approx 100cc of serosang drainage each day. the drain output will need to be monitored regularly at the ltac with a plan for follow up with ir once the output decreases to <10cc/day. interventional radiology contact details were included in the page 1 and both pt/family were given instructions regarding the importance of re-imaging and surgical follow up once the drain output decreases and it is removed. . # pneumonia. the patient had been diagnosed with pneumonia at his rehab hospital and was given one dose of vancomycin on and continued on ceftriaxone and vancomycin for a 10 day course. he was initially confused and this resolved as his hypotension was managed. cxr at showed rll infiltrate and bilateral pleural effusions secobdary to his volume status. he completed a course of abx for hap after which he remained afebrile without respiratory complaints . # esrd on hd: mr had worsening renal unction prior to admission and this was initially felt due to worsening of his plasma cell dyscrasia and previous rcc s/p nephrectomy. pt had been started on hd 3 weeks prior to admission and presented with massive volume overload/anasarca that was complicated by his low albumin. while in house, he underwent almost daily hd/uf for aggressive volume removal but this was limited by low bps at hd. this was managed with midodrine/albumin as needed. latterly his bp permitted significant fluid removal of 3-4l without the aid of albumin and his anasacra greatly improved as a result of this. he was discharged with plan continued hd on mon, wed, fri. . # fast af: this was noted on the outside hospital ecg, and required iv diltiazem and resolved. he continued in sinus rhythm throughout the remainder of his hospital stay and he was monitored on telemetry. he did not require any other nodal agents and was not anticoagulated given his large hematoma and relative thrombocytopenia. . # left eye conjunctivitis: on there was noted evidence of left conjunctival erythema and exudate clinically compatile with mild bacterial conjunctivitis. he was therefore treated with a 1 week course of erythromycin eye drops which stopped . this resolved before his treatment course was completed. . # pericardial effusion: on there was evidence of a moderate pericardial effusion on echo and was not causing tamponade. he went on to a repeat echo which showed normal lv/rv (lvef>55%)and a small to moderate sized circumferential pericardial effusion most prominent (1.3cm) around the apex of the right and left ventricle and relatively little inferolateral (<0.5cm) to the left ventricle with no echocardiographic signs of tamponade. . # plasma cell dyscrasia: initially documented on admission to be myeloma but on further discussion with his outpt hematologist, it was felt that the exact nature of his plasma cell dyscrasia was not entirely understood. pt had been treated with melphalan and prednisone prior to admission which he did not tolerate well. his pathology was reviewed at and a second opinion is awaited. he was noted to have a large mcv while in house with high retic count and further hematology managment was deferred to the outpatient setting. his hematologist dr was planning for more chemotherapy but this on hold until his acute issues have resolved. . # malnutrition/ascites: pt presented with a low albumin and anasarca. pt was noted to have poor oral intake which was felt to be as a result of abdominal dyscomfort. he was therefore treated with tpn for approx 2 wks and as his fluid collection decreased in size, his intake improved. albumin with trending back to normal and nutrition consult felt he could maintain his caloric requirements without tpn. pt should continue to ensure tid with meals and will need follow up with nutrition. . # dm2. this was initially treated with hiss but he had a poor nutrition status and minimal oral intake. he was initially treated with tpn including insulin. pt was transitioned back to regular diet when his intake improved and his blood sugars remained well controlled without any short acting insulin coverage. the gabapentin was decreased to 100mg qhs and neuropathic pain was controlled. . # anisocoria: noted to have left pupil larger than right which was persistent with gcs 15/15. no focal neurological deficit. . #. hypothyroidism: pt was noted to have an elevated tsh at 17 and low ft4 0.91 on . we increased his levothyroxine dose to 137.5mcg daily, tsh/ft4 should be repeated in weeks. . # follow up*** 1. ct-abd showed right middle lobe ground-glass nodules measuring up to 8 mm, possibly infectious or inflammatory in etiology. he was treated with an eight day course of abx for hap. radiology recommended followup in three months with ct-chest to document stability especially in a patient with known primary malignancy. 2. needs follow up thryoid function tests in 3. needs follow up with hematology once these acute issues resolved medications on admission: -tylenol 650mg po q4h prn pain, fever -morphine 2mg iv q6h prn pain -tramadol 50mg po bid prn pain -tramadol 50mg at 8pm standing -synthroid 125mcg daily -vanco 500mg once on -ceftriaxone 1gm iv daily stopping -gabapentin 100mg , 200mg hs -reglan 10mg q6h -nephrocaps daily -simvastatin 40mg daily -allopurinol 100 mg daily -aspirin 81 mg daily -procrit 10,000 units with hemodialysis -nexium 40 mg po daily -multivitamin daily -novolog sliding scale -diet: renal/diabetic diet with 40grams of nepro tid discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. tramadol 50 mg tablet sig: one (1) tablet po q12h (every 12 hours) as needed for pain. 8. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 9. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 10. midodrine 5 mg tablet sig: two (2) tablet po qhd (each hemodialysis). 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 12. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). 13. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 14. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 16. levothyroxine 137 mcg capsule sig: one (1) capsule po daily (daily). 17. sodium chloride 0.9 % 0.9 % parenteral solution sig: ten (10) ml intravenous prn (as needed) as needed for line flush. 18. outpatient lab work please check tsh and ft4 in 6 weeks and forward results to rehab doctor/pcp. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: intra abd hematoma s/p ir guided drain insertion end-stage renal failure on hemodialysis episode of rapid atrial fibrillation in the context of sepsis pneumonia (hosp acquired) hypotension . secondary diagnoses: plasma cell dyscrasia igm - not myeloma but ? wadenstrom's variant s/p melphalan and prednisone renal cell carcinoma s/p left nephrectomy type 2 diabete mellitus with peripheral neuropathy and gastroparesis end-stage renal failure on hemodialysis hypertension coronary artery disease hyperlipidemia benign prostatic hyperplasia gout hypothyroidism gastro-esophageal reflux disease s/p splenectomy for itp s/p hernia repair discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure looking after you during your stay at the . . you were initially transferred from with confusion and a low blood pressure requiring medications to support this in addition to an increasing collection of blood within the abdomen. the outside hospital had taken a chest x-ray which showed pneumonia and you were treated with intravenous antibiotics for this completing a 10-day course. you had no further fevers during your hospital stay. you also briefly had a fast irregular hreat beat which was treated with medications to slow the heart and resolved with no futher episodes. your confusion resolved. . given inncreasing abdominal pain, you were reassessed with a ct-scan which showed an enlarging collection of blood (called a hematoma) in your abdomen. you were transferred to the icu for monitoring and had an angiogram to look at the blood vessels and there was no evidence of active bleeding or any swellings of the blood vessels. after this, you had a drain inserted by interventioanl radiology under ultrasound guidance to drain the hematoma. following initial drainage of this, your blood pressure was much easier to control as this was felt to have been compressing one of the major veins in the abdomen. the cause of this collection of blood is not known but may have been related to a bleed from the gut. we had many discussions with interventioanl radiology and once your drain is drainig <10ml in 24 hours you will have your abdomen re-scanned and as necessary your drain removed or re-positioned. you will also be followed up by the general surgeons on regarding this blood collection. you required no transfusions while at the although you did have some prior to your arrival here and your blood count remained stable. due to the blood collection, we held your aspirin and pain was controlled with appropriate pain-killers and improved during your admission. your drain was still draining on trasfer to rehab on . . you also required frequent dialysis due to having a lot of additional fluid in your body. they were able latterly to take off 3-4 liters of fluid but there were problems regarding your blood pressure which tended to drop during dialysis. for this you received the medication midodrine and occasionally required fluids to support your blood pressure with albumin. you did well on your dialysis and on transfer you will have a monday/wednesday/friday dialysis regimen. . you were incidentally found to have right sided lung nodules on your ct scan which was in teh context of being treated for pneumonia. as a precautionary measure, these should be followed up with a repeat scan in 3 months. . you initially required nutrition through the veins due to poor oral intake but latterly you no longer required this and were eating well. . you also noted a loose left upper incisor tooth and this should be followed up by a dentist at your rehab. . you were treated for a possible bacterial infection on the outside of the eye called bacterial conjunctivitis with eye drops. this resolved. . you were discharged to rehab on . . . medication changes: we stopped aspirin due to your abdominal blood collection we increased your levothyroxine to 137mcg daily given your kidney function we reduced gabapentin to 100mg daily . patient instructions: once you are draining <10ml/day you should be reassessed with a scan and seen by interventional radiology. your dialysis regimen will be monday/wednesday/friday. followup instructions: we made the following appointments for you: . department: general surgery/ when: tuesday at 3:00 pm with: acute care clinic building: lm bldg () campus: west best parking: garage . regarding your loose tooth, you should make a dentistry appointment to address this. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances hemodialysis percutaneous abdominal drainage arterial catheterization aortography arteriography of other intra-abdominal arteries central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified acidosis hyperpotassemia anemia in chronic kidney disease end stage renal disease other chronic pain renal dialysis status coronary atherosclerosis of native coronary artery unspecified pleural effusion acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease unspecified disease of pericardium compression of vein hemorrhage of gastrointestinal tract, unspecified personal history of malignant neoplasm of kidney acquired absence of kidney delirium due to conditions classified elsewhere leukocytosis, unspecified gastroparesis nutritional marasmus cyst of kidney, acquired other acute and subacute forms of ischemic heart disease, other anisocoria other fluid overload macroglobulinemia other specified disorders of the teeth and supporting structures other specified disorders of adrenal glands unspecified disorder of plasma protein metabolism other conjunctivitis other secondary thrombocytopenia 

Answer: The patient is high likely exposed to