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: imitrex / iodine-iodine containing attending: chief complaint: unresponsive major surgical or invasive procedure: extubation () history of present illness: ms. is a 53 year old female with type i dm with insulin pump hl, hypothyroid, dyslipidemia, hx of tracheostomy after mvc, psychiatric disorder who was found unresponsive on her couch today. per ems report, she was noted to have rectal temp of 90.7. blood glucose was read as "high". she was reported to have two days of vomiting. her insulin pump was noted to be shut off. she was subsequently taken to where her exam was notable for arousle to pain with eyes deviated to right, bp of 99/57 and pulse of 87. abg with ph of 6.87, ua normal except for ketones, glucose of 949, hco3 < 5, troponin of 0.392 and wbc of 37.9. she was started on insulin gtt, 2 amps of bicarb and cefepime/vancomycin. md notes from osh notes he turned off the pump, prior to sending to . sedation shut off in transit by , noted to not have response. at ed, initial vitals were 95.0. she was started on fentanyl/versed gtt/insulin 7 units. labs notable for abg of 7.11/40/456 on 500 x 15 fio2 of 100%, 5 peep; lactate of 4.5, hco3 of 10, lipase of 696 and glucose of 686. she got 4l at osh. 500 cc here at ed. she was subsequently admitted to micu for further evaluation and management. on arrival to the micu, she was intubated and sedated. her ex-husband confirmed that she started having nausea and vomiting for past two days with increasing confusion. he does not report her having any sick contacts except hospital visit two weeks ago for his pulmonary edema admission. she has not eaten out though she regularly goes to casino but no alcohol intake. he reports she has not had chest pain, shortness of breath, fever or chills. he reports she has not endorsed si to him. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: iddm osteoperosis fibromyalgia anxiety depression bipolar disorder s/p mva w/ multiple face/pelvic/spine fx -intubated x1 month, s/p trach hypothyroidism hyperlipidemia social history: the patient reports that she quit smoking since . 20 pack year smoking history. she does not drink any alcohol. family history: father had lung cancer with a history of smoking, as well a coronary artery disease. no known family exposure to tuberculosis. physical exam: admission exam general: intubated. sedated. heent: sclera anicteric, mmm, oropharynx clear, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: not assessed discharge exam vs: t: 97.4 bp: 129/47 p: 85 r: 16 18 o2: 98% on ra gen: nad, aaox3 heent: eomi, mmm cv: rrr, normal s1/s2, no m/r/g lungs: ctab, no wheezes, rhonchi or rales abdomen: soft, non-tender, non-distended ext: 2+ radial and dp pulses neuro: motor and sensory grossly intact in upper and lower extremeties, bilaterally pertinent results: labs on admission: 08:20pm blood wbc-35.9* rbc-4.30 hgb-13.1 hct-43.4 mcv-101* mch-30.5 mchc-30.3* rdw-14.1 plt ct-272 05:11am blood wbc-8.6# rbc-4.24 hgb-12.6 hct-38.9 mcv-92# mch-29.7 mchc-32.4 rdw-14.3 plt ct-226 05:00am blood wbc-10.3 rbc-3.93* hgb-12.0 hct-36.0 mcv-92 mch-30.6 mchc-33.4 rdw-14.7 plt ct-144* 04:00am blood wbc-7.8 rbc-3.72* hgb-11.1* hct-34.2* mcv-92 mch-29.8 mchc-32.4 rdw-15.0 plt ct-106* 08:20pm blood neuts-76.2* lymphs-13.7* monos-8.9 eos-0.5 baso-0.8 08:20pm blood pt-10.2 ptt-22.9* inr(pt)-0.9 05:11am blood fibrino-330 08:20pm blood glucose-686* urean-36* creat-1.5* na-151* k-4.2 cl-110* hco3-10* angap-35* 05:11am blood glucose-307* urean-29* creat-1.1 na-158* k-4.2 cl-128* hco3-24 angap-10 05:00am blood glucose-112* urean-11 creat-0.7 na-146* k-3.3 cl-116* hco3-21* angap-12 02:01pm blood glucose-252* urean-7 creat-0.5 na-142 k-3.8 cl-112* hco3-23 angap-11 08:20pm blood alt-29 ast-39 ck(cpk)-147 alkphos-92 totbili-0.2 08:20pm blood lipase-696* 05:00am blood lipase-54 08:20pm blood albumin-3.8 02:01pm blood calcium-8.0* phos-2.2* mg-2.5 iron-87 02:01pm blood caltibc-246* hapto-175 ferritn-159* trf-189* 02:01pm blood ret aut-0.5* 05:00am blood vitb12-617 01:13pm blood %hba1c-11.6* eag-286* 11:45am blood triglyc-62 08:20pm blood osmolal-369* 11:45am blood tsh-0.18* 11:50pm blood tsh-0.21* 11:45am blood t3-68* free t4-1.2 08:20pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg labs on discharge: 07:20am blood wbc-6.8 rbc-3.91* hgb-11.6* hct-35.5* mcv-91 mch-29.6 mchc-32.5 rdw-14.7 plt ct-97* 07:20am blood plt smr-low plt ct-97* 02:01pm blood ret aut-0.5* 07:20am blood glucose-236* urean-6 creat-0.5 na-148* k-4.1 cl-115* hco3-28 angap-9 02:01pm blood ld(ldh)-324* 02:01pm blood caltibc-246* hapto-175 ferritn-159* trf-189* 01:13pm blood %hba1c-11.6* eag-286* imaging: ct head (): "slightly limited study due to patient motion demonstrates no acute intracranial process." ct abdomen (): "mild ascending colonic bowel wall thickening likely underdistension and accordingly felt probably due to artifact; however, mild colitis cannot be completely excluded. emphysematic changes and scarring is noted in the lung apices. bibasilar atelectasis. old deformity of t5 vertebral body. old rib deformities noted bilaterally. no free air or free fluid within the abdomen. no focal fluid collections. borderline features suggesting fatty liver. esophagus wall is mildly thickened around the feeding tube." micro: urine urine culture-final inpatient mrsa screen mrsa screen-final inpatient urine urine culture-final emergency blood culture blood culture, routine-pending emergency blood culture blood culture, routine-pending emergency brief hospital course: 53 year old woman with dm type i on insulin pump at home found unresponsive at home in dka, extubated and transferred out of the micu on sq insulin to the medical floor, with no infectious etiology identified. # diabetic ketoacidosis: unclear etiology, however, it appears there was pump dysfunction for 48 hours prior to admission. the patient arrived from osh, intubated, for management of dka. she was directly admitted to the micu, where she received iv insulin until her anion gap closed. at the osh, she was on vancomycin and cefepime, which was changed to vancomycin and zosyn while here, and subsequently discontinued after 48 hours for lack of clinical signs and symptoms of infection. she was extubated within 24 hours at . after her anion gap closed, she was transferred to the floor, where she was continued on subcutaneous basal-bolus insulin. she was discharged to an immediate appointment where she will receive insulin pump teaching and increased basal dosing instructions. she was counseled to call her physicians immediately should her glucose be >400 in order to act quickly and prevent recurrence of dka. # thrombocytopenia: the patient had a platelet drop from a baseline of mid-200s to 97. hitt was considered, although 4t score is 2 (2 for thrombocytopenia, 0 for timing, 0 for thrombosis, and 0 for other cause). the most likely explanation for her thrombocytopenia is hemodilution, although there may be some effect from vancomycin as well. a platelet factor 4 antibody is pending at the time of discharge, and she was given instructions to follow up with her pcp in two days to have a repeat cbc to evaluate her platelet count. # hypernatremia: secondary to free water deficit. her na was 148 on the day of discharge. she was encouraged to increase her free water intake and will have her sodium checked in two days at her follow up pcp . #anemia: increased ferritin with a lowered transferring are consistent with anemia of chronic inflammation in addition to hemodilution. she was guiac negative without any evidence of an acute gi bleed. #gerd: she was transitioned to lansoprazole while in the hospital, but her home omeprazole was restarted at discharge. #social situation: concern was raised in the icu about the behavior of her husband, who was preventing others from seeing ms. . she was seen again by social work on 7 with no identifiation of issues of imminent concern, but these issues should continue to be addressed as an outpatient. all other chronic medical conditions, including hyperlipidema, hypothyroidism, and depression were addressed with continuation of her home medications. the patient was full code throughout admission. transitions of care: - follow up platelet factor 4 antibody (negative) - recheck platelets - recheck sodium - ongoing glucose management and education medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. rosuvastatin calcium 40 mg po daily 2. ezetimibe 10 mg po daily 3. lamotrigine 75 mg po qhs 4. aripiprazole 5 mg po qhs 5. duloxetine 120 mg po daily 6. pregabalin 100 mg po tid 7. quetiapine fumarate 100 mg po qhs 8. levothyroxine sodium 125 mcg po daily 9. nicotine patch 14 mg td daily 10. tiotropium bromide 1 cap ih daily 11. albuterol inhaler 2 puff ih q4h:prn shortness of breath 12. alendronate sodium 70 mg po 1x/week (mo) 13. estring *nf* (estradiol) 2 mg vaginal q3months 14. oxycodone-acetaminophen (5mg-325mg) 1 tab po q6h:prn pain 15. aspirin 81 mg po daily 16. calcium 600 with vitamin d3 *nf* (calcium carbonate-vitamin d3) 600 mg(1,500mg) -400 unit oral 17. omeprazole 40 mg po daily 18. insulin pump sc (self administering medication)insulin aspart (novolog) (non-formulary) basal rate minimum: 1.3 units/hr basal rate maximum: 1.3 units/hr target glucose: 80-180 fingersticks: qac and hs discharge medications: 1. aripiprazole 5 mg po qhs 2. duloxetine 120 mg po daily 3. ezetimibe 10 mg po daily 4. lamotrigine 75 mg po qhs 5. levothyroxine sodium 125 mcg po daily 6. nicotine patch 14 mg td daily 7. pregabalin 100 mg po tid 8. quetiapine fumarate 100 mg po qhs 9. rosuvastatin calcium 40 mg po daily 10. albuterol inhaler 2 puff ih q4h:prn shortness of breath 11. alendronate sodium 70 mg po 1x/week (mo) 12. aspirin 81 mg po daily 13. calcium 600 with vitamin d3 *nf* (calcium carbonate-vitamin d3) 600 mg(1,500mg) -400 unit oral 14. estring *nf* (estradiol) 2 mg vaginal q3months 15. oxycodone-acetaminophen (5mg-325mg) 1 tab po q6h:prn pain 16. tiotropium bromide 1 cap ih daily 17. glargine 20 units breakfast glargine 20 units bedtime insulin sc sliding scale using hum insulin 18. omeprazole 40 mg po daily glargine 20 units bedtime insulin sc sliding scale using hum insulin discharge disposition: home discharge diagnosis: primary: diabetic ketoacidosis secondary: type i diabetes gerd depression hypothyroidism hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were recently admitted to for severe diabetic ketoacidosis. this crisis occurs when your glucose is very high and several organs are effected. you received continuous insulin and once your glucose improved, you were transitioned to subcutaneous insulin. you will see the doctors today who complete teaching and restart your pump at a higher insulin basal dose. in order to prevent a similar episode like this from happening again in the future, please call your doctor immediately if your fingerstick glucose check is critically high or greater than 500. it is important to act quickly when your glucose is this high. your platelets were low which may have been due to all the intravenous fluids you received, or perhaps one of your medications. additionally, your sodium is high. please drink increasing amounts of water over the next week (8 glasses/day). you have a follow up appointment with your pcp this where your labs will be checked including your platelets and sodium. we have perscribed you a subcutaneous insulin sliding scale, but this will be changed later today at your appointment at the when you restart your pump. it was our pleasure to take care of you while you were in the hospital. please do not hesitate to contact us with any questions, comments or concerns. with warm regards, your inpatient medicine team followup instructions: today 4:30pm dr: will restart your insulin pump at this appointment. department: when: friday at 10:30 am with: post clinic with dr phone: building: sc clinical ctr campus: east best parking: garage this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: thrombocytopenia, unspecified anemia, unspecified esophageal reflux unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism personal history of tobacco use other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure long-term (current) use of insulin osteoporosis, unspecified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation hyperosmolality and/or hypernatremia myalgia and myositis, unspecified diabetes with ketoacidosis, type i [juvenile type], uncontrolled mechanical complication due to insulin pump bipolar i disorder, most recent episode (or current) depressed, unspecified insulin pump status physical restraints status personal history of traumatic fracture 

Answer: The patient is high likely exposed to