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: codeine attending: chief complaint: overdose major surgical or invasive procedure: mechanical ventilation and intubation central venous line placement tunneled line placement hemodialysis fasciotomies x 2 history of present illness: 49m with past medical history significant for asthma, gerd, multiple psychiatric problems, heavy alcoholism and new lung nodule presents from outside hospital in rhabdomyolysis, renal failure, shock requiring 2 pressors of unknown etiology, as well as depressed mental status. . interval history reveals that apparently the wife found him this morning lying in the bathtub, where he apparently slept overnight after being involved in a domestic dispute. she found that he had taken more doses of his prescription meds than should, including all of his fluoxetine, ativan, ambien, and neurontin, and naproxen, and doxepin pills and he was again not responsive. he was taken to outside hospital where he was unresponsive and so was intubated for airway protection. trauma cxr pelv there negative, as were head and c-spine ct (unknown whether trauma was involved initially). his labs there showed an anion gap acidosis, with rhabdomyolysis (ck of about 10,000), potassium of 7.1 ekg changes for which he was given calcium, insulin, bicarbonate. . arrived to our emergency department on dopamine and we have fed, with a wide complex ekg (qrs 170) and potassium of 6.5. he required 2 amps of calcium, bicarbonate, and after bicarbonate his qrs narrowed dramatically. . bedside echocardiogram and shock ultrasound revealed hyperdynamic ventricular function, normal caliber aorta, ivc which appeared very compressible with respiratory variability indicating under resuscitation. he was aggressively fluid resuscitated and subsequently weaned off the dopamine during his ed stay. . prior to transfer he dropped his pressures and was restarted on dopamine and levophed. . . on arrival to the micu, he is intubated and sedated. . wife says he has had no access to over the counter medications specifically denying benadryl. past medical history: asthma gerd multiple psychiatric problems heavy alcoholism recently discovered lung nodule undergoing work up lung abcess social history: - tobacco: 40 pack year history - alcohol: heavy at times unknown daily quantitiy - illicits: not to his wife knowledge he has been hanging out with people his wife feels to be unsavory family history: lung cancer on his mothers side physical exam: admission vitals: p107 bp 137/75 98% intubated general: intuabted and sedated heent: sclera anicteric, ett in place, ngt in place pupils round and reactive. neck: supple, jvp not elevated, no lad cv:tachycardia rrr no mrg lungs: bilateral breathsounds cta abdomen: soft, non-tender, non-distended, absent bowel sounds gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge: general: patient alert and oriented in no acute distress heent: sclera anicterica, pearla, eomi cv: no mrg lungs: ctab abdomen: soft, non-tender, non-distended neuro: cn 2-12 intact, strength 5/5 in the left upper ext, strength 4/5 in the right upper ext with proximal muscles weaker than distal, right lower ext with proximal weaker than distal pertinent results: pertinent labs: 01:48pm blood wbc-15.9* rbc-4.27* hgb-11.6* hct-36.5* mcv-86 mch-27.3 mchc-31.9 rdw-15.5 plt ct-285 06:04pm blood neuts-82* bands-0 lymphs-12* monos-5 eos-0 baso-0 atyps-0 metas-0 myelos-1* 01:48pm blood pt-12.6* ptt-32.9 inr(pt)-1.2* 06:04pm blood glucose-249* urean-35* creat-3.5* na-139 k-6.0* cl-99 hco3-20* angap-26* 09:04pm blood alt-214* ast-751* ck(cpk)-* totbili-0.5 06:04pm blood calcium-7.1* phos-6.7* mg-2.1 01:03am blood hapto-403* 04:31am blood caltibc-224* ferritn-240 trf-172* 03:45pm blood hbsag-negative hbsab-negative hbcab-positive 01:48pm blood asa-neg ethanol-26* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-pos 03:45pm blood hcv ab-positive* 02:58pm blood type-art po2-122* pco2-36 ph-7.25* caltco2-17* base xs--10 01:49pm blood glucose-182* lactate-6.4* na-140 k-6.5* cl-108 calhco3-13* 11:24pm blood glucose-170* lactate-2.0 k-6.4* 06:58pm blood freeca-0.97* 02:11pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 05:27am blood hiv ab-negative. . **final report ** wound culture (final ): enterococcus sp.. >15 colonies. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r linezolid------------- 2 s penicillin g---------- =>64 r vancomycin------------ =>32 r . ecg : wide complex tachycardia with left bundle-branch block morphology and left superior axis suggestive of supraventricular tachycardia with intraventricular conduction delay. however, cannot exclude ventricular tachycardia or accelerated idioventricular rhythm. no previous tracing available for comparison. . ecg : sinus tachycardia with atrial premature beats. low qrs voltage in the limb leads. compared to tracing #1 atrial ectopy is new. qrs voltage in the precordial leads is increased. . leni : no evidence of deep vein thrombosis seen in either leg. note is made of some fluid tracking in the region of the left popliteal fossa. note is also made of prior left lower leg amputation. . head ct : 1. new hypodensity in the genu of the left internal capsule is suggestive of an acute infarction. a dedicated brain mri is recommended for further evaluation. 2. ethmoidal and sphenoidal mucosal thickening with air-fluid levels and aerosolized secretions is suggestive of acute sinusitis. . tte : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. right atrial appendage ejection velocity is good (>20 cm/s). no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast at restx2 (late bubbles are seen at 5 beats c/w transpulmonic passage). global left ventricular systolic function is normal. there are simple atheroma in the aortic arch and descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no discrete vegetations are seen. trace aortic regurgitation is seen. the anterior mitral valve leaflet is mildly thickened, but without discrete vegetation. physiologic mitral regurgitation is seen (within normal limits). there is no pericardial effusion. impression: no echocardiographic evidence of endocarditis seen. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast at rest. normal biventricular function. . carotid u/s : duplex was performed of bilateral carotid arteries. no significant plaque is seen bilaterally. . ct abdomen 1. small bowel obstruction with a transition point in the right lower quadrant. no evidence for free air or bowel ischemia. 2. nodular consolidative opacities seen at the right lung base are likely representative of developing pneumonia. 3. distended gallbaldder with enhancing wall and surrounding fluid may be related to volume status. however, if there is clinical concern for cholecystitis a hida scan should be obtained. 4. small trace bilateral pleural effusions with adjacent compressive atelectasis. . ct chest/abdomen/pelvis 1. widespread multifocal pneumonia involving primarily right lung but also left upper lobe. 2. small bilateral pleural effusions. 3. segment liver hypodensity too small to fully characterize. 4. interval improvement of small-bowel obstruction. 5. right lung base pleural calcifications. brief hospital course: 49m with past medical history significant for asthma, gerd, multiple psychiatric problems, heavy alcoholism and new lung nodule (being worked up for malignancy, +pet, no bx yet) presents from outside hospital with tca overdose who initially presented with rhabdomyolysis, renal failure and shock initially requiring 2 pressors now weaned off pressors. icu course has been complicated by oliguric/anuric renal failure requiring continued cvvh/hd, compartment syndrome s/p fasciotomies x 2, new finding of stroke, sbo (now resolved), and persistent leukocytosis and fever. 1. ingestion/overdose with resulting respiratory failure requiring mechanical ventilation: patient found down with empty pill bottles by his side. tox screen was positive for tcas and etoh and otherwise negative. initially presented with ams, metabolic acidosis, hypotension and qrs >100 suggestive of tca overdose. he was started on intravenous bicarbonate infusion and his qrs narrowed appropriately. he was started on neosynephrine and levophed for his hypotension (presumed to be more likely drug effect than sepsis) which was successfully weaned on . serial ecgs showed no signs of widening. patient was initially intubated for airway protection. extubation was attempted on but failed due to massive bilious emesis and concurrent aspiration. he was successfully extubated on . circumstances of ingestion are unclear. appears to have occurred after night of drinking in the context of domestic dispute. per family, patient had been under increased stress for the past several months as he was in the process of being worked up for potential lung cancer. when patient had regained his speech capabilities, psychiatry was reconsulted and they felt that he should be started on anti-depressant monotherapy after the course of linezolid is completed. 2. sepsis secondary to pneumonia and cvl: though patient intially presented with leukocytosis, he showed no signs of infection on first presentation. then from onwards, patient's temperature was noted to be gradually increasing in tandem with his white count until he finally became febrile to 102 on . patient was empirically started on vanc, zosyn, and flagyl. his lines were discontinued and foley was changed. the patient??????s gallbladder was visualized and no cholecystitis was seen. there was concern for c.diff given patient's concurrent abdominal distention so he was empirically started on treatment for c.diff with concurrent po vanc, which was discontinued after negative c. diff pcr. ct chest indicated multifocal pneumonia likely from aspiration event during first attempted extubation (see below). plan for antibiotics was to continue vanc and zosyn for pna for an eight day course until and azithromycin for a five day course (added for atypical coverage of pna) until . on , culture tip from catheter was positive for vre. patient was switched to linezolid on for 14 day course and vancomycin was discontinued. blood cultures showed no growth after. hiv serologies negative. on discharge patient had completed the antibiotic course for his pneumonia and is on linezolid for the vre+ central line culture. 3. acute renal failure / acute tubular necrosis - renal failure secondary to rhabdomyolysis, with peak ck in the 60,000 range. patient initially with elevated potassium and phosphate and low calcium requiring agressive correction. pt was started on cvvh then transitioned to hd for monday, wednesday, friday sessions after tunneled line was placed by ir. per renal, chance of renal recovery remains slim. per renal, recommendations on discharge include measure interdialytic cr and obtain a 24 hour urine collection for a urea and creatinine clearance once urine outpute is > 400. on the day of his discharge patient had a urine output of around 200cc and will continue hd at his . 4. small bowel obstruction: on , the day of his first extubation attempt, patient experienced copious bilious vomiting with likely aspiration of bilious material. patient had been having some stool output prior but worsening abdominal distention was noted. subsequent ct scan showed small bowel obstruction with transition point in the rlq. cause felt to be likely ileus but infection was a concern as well so cdiff treatment was initiated. acs was consulted who felt there was no need for acute surgical intervention so patient was kept npo with an ng tube in place. repeat imaging showed improvement of the obstruction so patient's diet was slowly advanced as tolerated. 5. compartment syndrome due to rhabdomyolysis: patient had been found down in a bathtub. on presentation, noted to have tense right upper arm and right upper thigh. evaluated by orthopedics who noted that pressures in both compartments were elevated necessitating urgent fasciotomies the night of admission. wounds were closed on and wound vacs were placed until drainage ceased. ortho recommended starting ancef for prophylaxis for one weeks but this was discontinued once broad-spectrum antibiotics were initiated. sutures were removed on . ortho will follow-up with patient 2-4 weeks after discharge. 6. acute stroke: though patient presented with a negative head ct on admission, patient was noted to have decreased movement of his right side and repeat head ct showed a hypodensity in the internal capsule in the geniculate on the left side. lenis were negative for clot and tee was without vegetation or pfo. neurology was consulted who recommended asa and carotid ultrasounds which were negative. the patient did have a single episode of afib on which may be related to etiology of stroke. mri showed evidence of acute left subcortical infarct in the posterior frontal and anterior parietal lobes. mra head and neck showed no evidence of occlusion or aneurysm. neurology recommended anticoagulation with coumadin. patient was bridged with heparin and had therapuetic inr on discharge 7. atrial fibrillation with rvr: one episode in the am of . the patient had a non-sustained interval of afib with rvr with accompanying hypotension. it responded well to diltiazem bolus and patient remained in sinus rhythm for the remainder of his stay. started on anticoagulation per neurology recommendations as above. transitional issues - patient will need further work-up of his underlying lung nodules which are pet positive. - patient was found to be hcv positive on bloodwork here. will require liver follow-up as outpatient - renal recommendations as above: interdialytic cr and obtain a 24 hour urine collection for a urea and creatinine clearance once urine outpute is > 400 medications on admission: gabapentin 900mg qhs fluoxeptine 60mg qd doxepin 150mg qhs omeprazole ambien 10mg qhs ativan 1mg flomax naproxen discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 5. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 7. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily): give after hemodialysis. 8. sevelamer carbonate 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 9. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 10. lorazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 11. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 12. linezolid 600 mg/300 ml parenteral solution sig: three hundred (300) ml intravenous twice a day. 13. coumadin 2 mg tablet sig: one (1) tablet po once a day. 14. zolpidem 10 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: tricyclic antidepressant overdose acute respiratory failure requiring mechanical ventilation rhabdomyolysis acute kidney failure requiring hemodialysis compartment syndrome s/p fasciotomies x 2 embolic stroke wirh right sided hemiparesis and aphasia multifocal pneumonia small bowel obstruction atrial fibrillation secondary diagnoses: depression alcohol abuse lung nodules discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to the after you overdosed on prescription medications. you needed to be admitted to the intensive care unit and were initially dependent on a mechanical ventilator. you developed severe kidney failure requiring hemodialysis which you will continue after discharge. you also required surgeries on your right arm and right leg to help relieve the pressure that had built up there while you were unconscious. unfortunately, you also developed a stroke during your stay and will require continued rehab and anticoagulation as you regain your strength and speech. . we have made the following changes to your medications: # start coumadin 2mg daily by mouth with goal inr # start linezolid 600mg every 12 hours iv for 9 more days # start nephrocaps 1 daily # start sevelamer 1600mg three times daily # start thiamine 100mg daily # start senna 8.6mg twice daily as needed for constipation # start bisacodyl 10mg daily as needed for constipation # start nicotine patch to be tapered over 2 weeks # start advair twice daily # decrease gabapentin to 300mg daily after hemodialysis # stop fluoxetine # stop doxepin you will need ongoing psychiatric care and once the antibiotics stop, you may be able to start a low dose antidepressant. followup instructions: orthopedics: please follow up in 2-4wks with dr. . please call to make an appointment. department: infectious disease when: tuesday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage department: neurology when: tuesday at 8:30 am with: , md building: campus: east best parking: garage *you have also been placed on a cancellation list for this appointment. the office will contact you at home when a sooner appointment becomes available. name: , z. address: , , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis arterial catheterization arterial catheterization closed [endoscopic] biopsy of bronchus closure of skin and subcutaneous tissue of other sites other myectomy other myectomy other incision of soft tissue other incision of soft tissue diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation depressive disorder, not elsewhere classified sepsis suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents poisoning by benzodiazepine-based tranquilizers other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus poisoning by other sedatives and hypnotics suicide and self-inflicted poisoning by other sedatives and hypnotics cerebral embolism with cerebral infarction chronic obstructive asthma, unspecified accidents occurring in residential institution streptococcal septicemia suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics aphasia unspecified intestinal obstruction below knee amputation status rhabdomyolysis poisoning by other and unspecified anticonvulsants suicide and self-inflicted poisoning by other specified drugs and medicinal substances hemiplegia, unspecified, affecting unspecified side other alteration of consciousness mixed acid-base balance disorder acute alcoholic intoxication in alcoholism, unspecified other accidents other acute and subacute forms of ischemic heart disease, other solitary pulmonary nodule other early complications of trauma other anaphylactic reaction bloodstream infection due to central venous catheter poisoning by propionic acid derivatives encounter for change or removal of surgical wound dressing poisoning by tricyclic antidepressants poisoning by selective serotonin reuptake inhibitors 

Answer: The patient is high likely exposed to