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: nausea major surgical or invasive procedure: central venous line history of present illness: 69 yo female with t1dm on insulin pump, right bka , chronic lumbar disk disease on chronic narcotics, htn, hld, transfered to the icu after short floor stay after admission today for n/v/d and transfer to the icu for hypertensive emergency. she actually had a similar admission in for htn urgency and mild dka. she was on a labetalol gtt for and was transitioned to chlorthalidone. she was previously on lisinopril and clonidine patch as an outpatient. patient and husband as well as note corroborate that she started having vomiting, nausea on . per note, she called on to pcp, prior to admission, c/o nausea, vomiting attributing to possibly withdraw from morphine and oxycodone, and wanted to know if her morphine and oxycodone were ready to pick up. per note, she said that she ran out of both on friday morning. her sxs started saturday morning w/ nausea and vomiting. vomiting about 4-5x a day. she denied blood in vomit. her bs fasting the morning of was apparently 192. she denied dizzy, syncope, cp, sob, tremor, seizure, fever, chill, abdomen pain, blood in stool or black stool or any other changes in her bms. in the ed, it was reported that she presented asking for pain medication after she ran out at home. vs were initially, 97.6 62 219/95 16 97. she was given 2 l of ivf, morphine 5mg x1, ativan 1mg and zofran, and had nausea persistent and bp 200/90 prior to transfer. upon being asked again in the ed she stated that she took oxycodone for pain the day before, not sure how many, denies si, bglc 220. she was given hydralazine 10mg iv x 1. she had a ct head w/o elevated icp, or mass. cxr was done without acute cpp. on the floor, she told the team that she ran out of morphine but was able to take oxycodone at home. in ed sbp in 200s. given morphine, ativan and antiemetics. 220/100 on arrival on the floor, barely arousable but improving so did not get narcan. now somnolent but arousable. denied any other ingestions. given 10mg hydralazine, 10mg labtolol iv without change in bp. she did have an episode of bradycardia to the 30s with vomiting x 1. most recent finger stick was 230, given 6 units. on arrival to the micu, she was somnolent but arousable, oriented x 3. she denied pain though said that she did have a recent ha, now resolved. denied dyspnea or chest pain, abdominal pain. does still report nausea and she vomited a couple of times, biliouis material. she received 20mg labetolol iv x 3 with some initial effect in bp to sbps to 170s but these quickly rose to 190s. review of systems: (+) per hpi (-) denies fever, chills. denies headache (had recently but not now). denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations or recent symptoms. denies diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. past medical history: - h/o dvt, unknown when - dmi on insulin pump, patient unable to say dose. followed by . - peripheral neuropathy - h/o gastroparesis - chronic lbp/sciatica - htn - hyperlipidemia - hypothyroidism - pvd/pad - autonomic dysfunction, orthostatic hypotension - history of seizure characterized by becoming less responsive, oriented to name only, gaze deviation and left arm shaking. fs 297 and was in the setting of receiving cipro, neuro felt infection vs pres. - barretts esophagus on egd - depression - mi , no stents past surgical history: - malunion right intertrochanteric hip fracture with protrusion of screw s/p revision arthroplasty comminuted right intertrochanteric hip fracture s/p right hip fracture open reduction internal fixation (intramedullary nail) rle angiography rle sfa-at bpg with nrsvg angioplasty of vein graft , l hip hemiarthroplasty - hiatal hernia - s/p laminectomy - s/p hysterectomy social history: the patient lives with her husband. she is a former secretary. former tobacco use, quit in , previous 60 pack/yr history. no history of etoh or ivdu. family history: mother - coronary artery disease with mi in her 50s, died at age 84. father - coronary artery disease with mi in her 60s, died at age 82. physical exam: admission exam: vitals: 99.2, 225/90, 98, 97%, 27, finger stick 243 general: somnolent but arousable, orientedx3, no acute distress heent: sclera anicteric, dry mm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated 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 ext: warm, no edema. s/p right bka well healed. no ulcers neuro: eoemi, 4/5 strength hand grip and leg lift discharge exam: vitals: 98.7 98.2 132/56 (120-168/50s-80s) 70s 18-20 96-99% ra +2560/-2275 bsgs 140s general: a&ox3. nad. lying comfortably in bed. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated cv: regular rate and rhythm, normal s1 + s2, /vi sem. no rubs or gallops. lungs: transmitted upper airway sounds. otherwise, clear to auscultation bilaterally, no wheezes or rales. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, no edema. s/p right bka well healed. no ulcers neuro: moving all extremities spontaneously. no focal deficits. pertinent results: 12:00pm blood glucose-331* urean-26* creat-1.0 na-138 k-4.0 cl-102 hco3-23 angap-17 05:22pm blood glucose-261* urean-23* creat-0.9 na-138 k-3.7 cl-102 hco3-18* angap-22* 11:57pm blood glucose-119* urean-24* creat-1.0 na-142 k-3.2* cl-107 hco3-24 angap-14 05:11am blood glucose-289* urean-21* creat-1.0 na-139 k-4.1 cl-108 hco3-21* angap-14 02:40pm blood glucose-180* urean-17 creat-1.0 na-138 k-3.6 cl-110* hco3-20* angap-12 02:07am blood glucose-245* urean-16 creat-1.1 na-137 k-4.1 cl-107 hco3-21* angap-13 04:00pm blood glucose-202* urean-14 creat-1.1 na-136 k-3.8 cl-104 hco3-24 angap-12 07:28am blood glucose-256* urean-13 creat-1.0 na-133 k-3.6 cl-100 hco3-26 angap-11 04:45pm blood glucose-113* urean-18 creat-1.4* na-134 k-4.0 cl-101 hco3-25 angap-12 07:10am blood glucose-231* urean-19 creat-1.2* na-136 k-4.5 cl-103 hco3-24 angap-14 07:10am blood glucose-164* urean-24* creat-1.1 na-137 k-4.3 cl-103 hco3-28 angap-10 12:00pm blood calcium-9.3 phos-3.4 mg-1.6 05:22pm blood calcium-9.0 phos-3.3 mg-1.6 11:57pm blood calcium-8.4 phos-2.8 mg-1.5* 05:11am blood calcium-8.1* phos-1.9* mg-2.4 02:40pm blood calcium-7.9* phos-2.1* mg-1.9 02:07am blood calcium-8.4 phos-2.7 mg-2.3 04:00pm blood calcium-8.3* phos-2.7 mg-1.9 07:28am blood calcium-8.3* phos-3.1 mg-1.7 04:45pm blood calcium-8.6 phos-3.9 mg-1.8 07:10am blood calcium-8.0* phos-3.8 mg-1.7 05:22pm blood ck-mb-4 ctropnt-<0.01 11:57pm blood ck-mb-4 ctropnt-<0.01 05:11am blood ck-mb-4 ctropnt-<0.01 05:22pm blood alt-12 ast-21 ck(cpk)-118 alkphos-122* totbili-0.3 11:57pm blood ck(cpk)-90 05:11am blood ck(cpk)-107 12:00pm blood wbc-7.9 rbc-4.87# hgb-14.7# hct-45.4# mcv-93 mch-30.2 mchc-32.4 rdw-14.5 plt ct-217 05:11am blood wbc-11.9*# rbc-4.07* hgb-12.4 hct-37.7 mcv-93 mch-30.5 mchc-32.9 rdw-15.0 plt ct-239 02:07am blood wbc-8.5 rbc-3.63* hgb-11.0* hct-33.8* mcv-93 mch-30.3 mchc-32.5 rdw-14.5 plt ct-210 07:28am blood wbc-5.5 rbc-3.62* hgb-11.0* hct-33.9* mcv-94 mch-30.4 mchc-32.4 rdw-14.7 plt ct-155 07:10am blood wbc-5.8 rbc-3.71* hgb-11.2* hct-36.1 mcv-97 mch-30.3 mchc-31.1 rdw-14.3 plt ct-159 07:10am blood wbc-6.8 rbc-3.71* hgb-11.0* hct-34.8* mcv-94 mch-29.6 mchc-31.5 rdw-14.4 plt ct-169 06:06pm blood type-art po2-102 pco2-22* ph-7.51* caltco2-18* base xs--2 12:17am blood type- po2-47* pco2-45 ph-7.37 caltco2-27 base xs-0 05:38am blood type-central ve po2-45* pco2-38 ph-7.42 caltco2-25 base xs-0 06:06pm blood freeca-1.04* 03:10pm urine blood-sm nitrite-neg protein-300 glucose-1000 ketone-40 bilirub-neg urobiln-neg ph-6.5 leuks-neg 03:10pm urine rbc-1 wbc-1 bacteri-few yeast-none epi-2 renalep-<1 03:10pm urine color-straw appear-clear sp -1.012 03:10pm urine bnzodzp-neg barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg 11:00pm urine metanephrines, fractionated, 24hr urine-pnd . bcx x2 neg mrsa pos sputum contaminated . echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. compared with the prior study (images reviewed) of , the lv systolic function is now hyperdynamic. . ct head impression: no acute intracranial process. chronic microvascular ischemic disease, unchanged. . cxr impression: mild prominence of the interstitium may be technical; however, the possibility of mild pulmonary edema cannot be excluded. recommend clinical correlation. . renal us normal-sized kidneys with no evidence of renal artery stenosis. moderately elevated resistive indices bilaterally. . ekg sinus rhythm. borderline left atrial enlargement. cannot rule out old septal myocardial infarction. left axis deviation. compared to the previous tracing of the heart rate has decreased. qs complexes are now noted in leads vi-v2. criteria for left anterior fascicular block are no longer seen. . brief hospital course: 69 yo female with t1dm (insulin pump), chronic lumbar disk disease, hypertension, hyperlipidemia, severe peripheral disease s/p right bka (), orthostatic hypotension (on salt tabs) who had been admitted on for nausea/vomiting/diarrhea in the setting of running out of opioids, was found to be hypertensive and had altered mental status, and mild dka, so she was transferred to the micu for ?hypertensive emergency. her blood pressures improved and confusion resolved. . # hypertensive urgency: patient has a history of hypertension, but because of orthostatic hypotension she takes salt tabs and is not on any home antihypertensives. in the ed, ms. had bp 219/95 p 62. she received 2l ns, morphine 5mg, and iv hydral 20 mg. head ct was negative for edema. on the floor, she received iv hydral 10mg x1 and labetalol, but her sbps only temporarily dropped below 200. she was transferred to the micu, where she was started on labetalol gtt and transitioned to po labetalol. her bps remained elevated (sbps 160s-180s), but pcp recommended goal ~160 given orthostatic hypotension. she was transferred to the floor, where because of relatively low bps 120s-140s her labetalol was weaned and she was transitioned to lisinopril 5mg and then lisinopril 2.5mg. she was discharged on lisinopril 2.5 mg. in the am, prior to getting her medications her bp was as high as 180, but throughout the rest of the day her sbps were 120s-140s. she underwent a renal artery ultrasound that showed no evidence of renal artery stenosis. serum metanephrines and 24-hr urine metanephrines were collected and pending at the time of discharge. . # orthostatic hypotension: patient with known orthostatic hypotension, which is why she has not been on antihypertensives at home. in micu sbps 160->120. improved on the floor, but still positive on lisinopril 2.5 mg at the time of discharge although asymptomatic (sbp 151->129). likely a component of autonomic dysfunction due to diabetes. . # altered mental status: in the ed, the patient was intermittently confused. her insulin pump was removed, she received morphine 10mg and ativan 2mg iv. her serum and urine tox screens were negative, except for opioids. on arrival to the floor, she was somnolent but arousable and interactive, but minimally conversational and orientation could not be assessed. in the micu, she returned to her baseline mental status (a&ox3, conversational) and remained there for the remainder of this admission. head ct revealed no hemorrhage, edema, or midline shift. she was afebrile and had negative bcx x2. ekg showed rbbb, but no st-changes and cardiac enzymes were negative x3. the mental status changes were likely contributed to by opioid intoxication, mild dka, and possibly severe hypertension. . # respiratory alkalosis: on arrival to the floor, the patient had a respiratory alkalosis (ph 7.51, pco2 22). she was somnolent, but arousable. this was resolved by four hours later and likely was due to opioid intoxication. . # dka: patients insulin pump was removed in the ed and by the time she was on the floor she had an anion-gap metabolic acidosis (hco3 18, anion gap 18). overall blood was alkalemic due to a primary respiratory alkalosis. she received insulin 6 units, insulin 10 units, and was put on an insulin drip. was consulted. the anion gap was corrected by hd3. she was switched over to sliding scale and then restarted on her home insulin pump and regimen. at the time of discharge, her bsgs were stable ranging between 130s and 190s (mostly 140s). she was r/o for an mi and there were no signs of infection. . # ekg changes: initial ekgs revealed a new rbbb. cardiology was consulted and thought likely to be rate related. tte revealed hyperdynamics with no wall motion abnormalities. cardiac enzymes were negative x3. the rbbb was resolved on hd2. . # : likely pre-renal. on the floor, creatinine bumped to 1.4 (from 1.0). she received 1l ns bolus and her urinary output increased and creatinine was downtrending (1.1 on discharge). . # chronic pain: patient has baseline phantom pain in right leg (s/p bka). extremities were warm and well perfused with dopplerable pulses. pain was reasonably controlled on home gabapentin, mscontin , and oxycodone daily prn. . # hypothyroidism: patient was initially on iv levothyroxine when unable to tolerate po's, then transitioned back to home dose. . # pvd: continued on home plavix, zocor while able to take po. # depression: patient without complaints during this admission. continued on home meds. . # s/p right bka: worked with pt, who recommended ambulation and outpatient pt. . # transitional issues: - for bp checks. - continue biweekly pt - started lisinopril 2.5 mg po - stopped salt tabs - should follow-up with pcp regarding antihypertensive regimen. medications on admission: refresh 1 % eye drops prn plavix 75 mg daily citalopram 40 mg tab daily 1 tablet(s) by mouth once a day glucagon (human recombinant) 1 mg injection kit prn low sugar citracal + d 315 mg-200 unit tab fish oil 1,000 mg cap travatan z 0.004 % eye drops 1 drop ou daily lantus 100 unit/ml sub-q 5 units at bedtime sennosides 8.6 mg tab, 2 tablet(s) by mouth once a day humalog 100 unit/ml subq cartridge on insulin pump basal rate cyanocobalamin (vitamin b-12) 1,000 mcg tab daily morphine er 15 mg tab, 3 tablet(s) by mouth qam and 2 tab qpm sodium chloride 1 gram tab, 1 tablet(s) by mouth daily lorazepam 1 mg tab qhs for anxiety metoclopramide 10 mg tab by mouth 30 minutes before meals calcitriol 0.25 mcg cap daily zocor 40 mg tab daily omeprazole 20 mg cap, delayed release daily docusate sodium 100 mg cap daily levoxyl 88 mcg tab daily oxycodone 5 mg tab, prn pain gabapentin 400 mg cap, restasis 0.05 % eye dropperette, 2 drops(s) three times a day multivitamin cap daily folic acid 400 mcg tab discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. citalopram 40 mg tablet sig: one (1) tablet po once a day. 3. omega-3 fatty acids capsule sig: one (1) capsule po daily (daily). 4. travatan z 0.004 % drops sig: one (1) ophthalmic once a day: both eyes. 5. insulin glargine 100 unit/ml solution sig: five (5) units subcutaneous at bedtime. 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily): contact your pcp if you feel more lightheaded or dizzy. 7. sennosides 8.6 mg tablet sig: two (2) tablet po once a day. 8. humalog 100 unit/ml cartridge sig: 100 units/ml subcutaneous on insulin pump basal rate. 9. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 10. morphine 15 mg tablet extended release sig: three (3) tablet extended release po qam (morning). 11. morphine 15 mg tablet extended release sig: two (2) tablet extended release po at bedtime. 12. lorazepam 1 mg tablet sig: one (1) tablet po every six (6) hours as needed for anxiety. 13. metoclopramide 10 mg tablet sig: one (1) tablet po (3 times a day). 14. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 15. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 16. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 17. docusate sodium 100 mg capsule sig: one (1) capsule po once a day. 18. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 19. oxycodone 5 mg tablet sig: one (1) tablet po daily (daily) as needed for pain. 20. gabapentin 400 mg capsule sig: one (1) capsule po (3 times a day). 21. restasis 0.05 % dropperette sig: two (2) ophthalmic three times a day. 22. multivitamin tablet sig: one (1) tablet po daily (daily). 23. folic acid 400 mcg tablet sig: one (1) tablet po once a day. 24. refresh celluvisc 1 % dropperette sig: one (1) ophthalmic once a day as needed for dry eyes. 25. glucagon emergency 1 mg kit sig: one (1) injection once a day as needed for low sugar. 26. citracal + d maximum 315-250 mg-unit tablet oral 27. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*1* 28. outpatient physical therapy please resume outpatient physical therapy two days a week. discharge disposition: home with service facility: partners discharge diagnosis: narcotic withdrawal hypertensive urgency dka discharge condition: a&ox3. vss. bsgs well controlled 130s-180s. discharge instructions: dear ms. , it was a pleasure taking care of you here at . when you first arrived you were confused and your blood pressure was very high. we controlled your blood pressure with medications and started you on a new medication lisinopril. given your history of low blood pressure, you should be careful when getting up quickly and discuss this medication with dr. . your confusion improved when your blood pressures decreased. prior to your arrival you reported some vomiting and diarrhea. we helped hydrate you with intravenous fluids. your vomiting and diarrhea resolved and we were able to stop the intravenous fluids. because of your confusion, we had removed your insulin pump. as you improved we resumed your home insulin pump with corrections and evening lantus, as you did prior to your hospitalization. during your hospitalization, you were seen by physical therapy. they recommended continuing outpatient physical therapy. you will be visited by nurse to help check your blood pressures. the following changes were made to your medications: --start taking lisinopril 2.5mg by mouth daily for high blood pressure. --stop taking sodium chloride. followup instructions: provider: , dpm phone: date/time: 10:30 provider: , md phone: date/time: 1:15 provider: , md phone: date/time: 9:50 procedure: venous catheterization, not elsewhere classified diagnoses: toxic encephalopathy acute kidney failure, unspecified unspecified acquired hypothyroidism polyneuropathy in diabetes depressive disorder, not elsewhere classified other opiates and related narcotics causing adverse effects in therapeutic use other and unspecified hyperlipidemia alkalosis long-term (current) use of insulin malignant essential hypertension other and unspecified disc disorder, lumbar region atherosclerosis of native arteries of the extremities, unspecified below knee amputation status diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled orthostatic hypotension 

Answer: The patient is high likely exposed to