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: patient recorded as having no known allergies to drugs attending: chief complaint: s/p mvc with acute liver failure and acute renal failure major surgical or invasive procedure: ng tube placement history of present illness: 42 y/o woman with history of bipolar disorder, substance abuse, hep c, copd and dvt on coumadin who initially presented to after an mvc. patient was notably somnolent during trauma work up and labs were drawn showing an alt of 11,0000, ast 9000, creatinine 3.0, hct 44, inr>15 and tylenol level of 15. pt was given nac (inappropriately dosed) and was transferred to for further management. . on arrival to , initial vs were: t 97.7 bp 112/72 hr 126 rr 14 sats 95% on ra. liver was consulted and recommended ct and ruq u/s (no dopplers) which were unrevealing. pt was given the nac with initial bolus and started on continuous gtt. she remained somnolent but arousable to vigorous stimulation. ng tube was placed with some coffee grounds returned and pt was given lactulose 30 ml. . on arrival to the micu, pt was sleepy and not responding to questions. however, upon arrival of her family, she became more alert, tearful and was able to answer some questions. she reported headache, abd pain, mild shortness of breath and denied any si or overdose attempt. . review of systems: unable to obtain with exception of above past medical history: copd/asthma/tobacco dependance le dvt on coumadin hepatitis c ivdu and substance abuse bipolar disorder s/p ccy chronic back & neck pain migraines social history: pt lives with her husband and has substance abuse history but denies active si or attempts to hurt herself. family reports excessive prescription drug abuse and occaisional alcohol use without h/o withdrawal. she has an ivdu history and other illicits. family history: mother died of respiratory disease physical exam: bp: 134/84 p: 125 r: 26 o2: 95% on 2l general: sleepy, confused, answering some questions heent: sclera injected, anicteric, perrla, mmm neck: supple, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rhythm, tachy, no murmurs, rubs, gallops abdomen: soft, mildly tender diffusely, bowel sounds present, no rebound tenderness or guarding gu: foley in place ext: warm, well perfused, 2+ pulses, no edema left hand with petechiae pertinent results: admission labs: 02:30am blood wbc-10.7 rbc-4.55 hgb-13.4 hct-39.0 mcv-86 mch-29.4 mchc-34.2 rdw-14.6 plt ct-206 02:30am blood neuts-86.8* lymphs-10.8* monos-1.1* eos-0.9 baso-0.4 04:25am blood pt-56.0* ptt-38.1* inr(pt)-6.3* 10:11am blood fdp-80-160* 09:10am blood fibrino-360 02:30am blood glucose-94 urean-38* creat-3.8* na-140 k-3.5 cl-107 hco3-17* angap-20 02:30am blood alt-* ast-4924* alkphos-170* totbili-1.4 02:30am blood lipase-55 02:28am blood ck-mb-notdone ctropnt-<0.01 09:10am blood albumin-3.7 calcium-8.0* phos-1.4* mg-2.5 11:30am blood ammonia-85* 04:08am blood tsh-1.1 . discharge labs: 06:51am blood wbc-7.9 rbc-2.89* hgb-8.3* hct-25.7* mcv-89 mch-28.6 mchc-32.2 rdw-15.0 plt ct-378 06:51am blood pt-16.1* ptt-89.2* inr(pt)-1.4* 06:51am blood glucose-88 urean-18 creat-2.2* na-140 k-3.8 cl-103 hco3-26 angap-15 06:51am blood alt-43* ast-15 alkphos-62 totbili-0.2 06:51am blood calcium-9.0 phos-4.5 mg-2.2 . anemia studies: 05:04am blood caltibc-265 vitb12-665 folate-10.3 ferritn-221* trf-204 05:04am blood ret aut-2.7 . toxicology: 02:05am blood acetmnp-neg 02:30am blood asa-neg ethanol-neg acetmnp-15.7 bnzodzp-neg barbitr-pos tricycl-neg . microbiology: . urine culture: no growth mrsa screen: negative urine culture: no growth vre swab: negative rpr: non-reactive blood cultures x 2: negative . hepatitis c - riba test result reference range/units hcv ab, riba positive a negative band pattern 5-1-1 reactive a nonreactive (p)/cl00 (p) c33c nonreactive nonreactive c22p reactive a nonreactive ns5 nonreactive nonreactive hsod nonreactive nonreactive . ekg : sinus tachycardia. low inferior and precordial lead t wave amplitude is non-specific and may be within normal limits. no previous tracing available for comparison. . imaging: . ruq ultrasound : no biliary obstruction, focal liver lesion or portal venous thrombosis. . ct abdomen/pelvis : 1. no focal liver lesions or evidence of cirrhosis on this non-contrast study. 2. hepatic hypoattenuation compatible with steatosis or edema. 3. status post cholecystectomy. . ruq ultrasound with doppler : 1. normal doppler arterial and venous evaluation of the liver. 2. normal kidneys, no hydronephrosis. . bilateral lower extremity ultrasound : 1. left common femoral and superficial femoral partially occlusive dvt and completely occlusive left popliteal venous dvt. 2. no dvt in the right lower extremity. . picc placement : uncomplicated ultrasound and fluoroscopically-guided double-lumen picc line placement; the internal length is 35.5 cm with its tip at cavoatrial junction; the line is ready to use. . endoscopy: . colonoscopy : stool in the colon polyp in the sigmoid colon polyp at 1cm in the colon grade 1 internal hemorrhoids otherwise normal colonoscopy to cecum recommendations: stool in colon. poor prep. unable to fully visualize mucosa. penduculated and sessile polyp. pedunculated polyp could be potential source of bleeding. no polypectomy performed given patient on coumadin and heparin. patient will need repeat full colonoscopy and polypectomy once completed course of anticoagulation. . egd : erythema in the fundus compatible with mild gastritis otherwise normal egd to third part of the duodenum brief hospital course: 42 y/o f with history of bipolar disorder, copd, substance abuse and recent mvc transferred with mental status changes and acute liver and kidney failure in the setting of an overdose. . # acute liver failure: the etiology of the patient liver failure was likely toxin mediated (given ingestion of >30 grams of tylenol). there also may have been a component of ischemic injury. the patient was treated with nac and supportive care. her transaminases were alt 11,0000, ast 9000 prior to transfer and trended downward throughout her hospital course, with alt 43 and ast 15 at the time of discharge. tbili was never greater than 1.5. . # coagulopathy/anticoagulation/dvt: the patient has a left lower extremity dvt. her inr was elevated to 15 on presentation. this was thought to be due to acute liver injury. it was unclear if there was also a coumadin overdose. the patient was treated with vitamin k, with resolution of her coagulopathy. warfarin was restarted on , at which time the patient's inr was 1.1. at the time of discharge, the patient's inr was 1.4. her goal inr is 2.0 to 3.0. the patient was discharged on coumadin 5 mg daily. she will get her inr checked at her pcp's office on and . the patient will self-administer lovenox 80 mg daily for 5 days in order to provide a therapeutic bridge. . # acute kidney injury: the patient developed acute kidney injury, with creatinine peaking at 9.1 on . the patient did not require hemodialysis. her urine output eventually increased, and her creatinine fell steadily, reaching 2.2 at the of discharge. the suspected etiology of the patient's acute kidney injury was acute tubular necrosis due to hypotension and medication toxicity. the patient will need to get a chem 7 checked (along with other labs) on . . # gastritis/gi bleeding: the patient's nasogastric tube initially had significant coffee-ground emesis. the patient was not initially scoped and was treated empirically for gastritis with sucralfate and pantoprazole. her hematocrit initially dropped from 39 on to 28 on . thereafter, the patient's hct remained stable, although there was a slow drift downward for which the patient underwent egd and colonoscopy on . egd showed mild gastritis. colonoscopy showed a polyp as explained below. the patient was discharged on sucralfate and pantoprazole. she will have a cbc checked (along with other labs) on . . # colon polyp: the patient underwent colonoscopy on to evaluate for a source of a slow hct drop. a single pedunculated 2.5 cm non-bleeding polyp of benign appearance was found in the sigmoid colon. a single sessile non-bleeding polyp of benign appearance was found at 1 cm. no biopsies or excisions were done due to the patient's anticoagulation. mucosal visualization was limited by poor prep. the patient will need to undergo repeat colonoscopy as an outpatient. she will have a cbc checked (along with other labs) on . . # dyspnea/chronic obstructive pulmonary disease: the patient developed dyspnea, which was felt to be multifactorial, related to fluid overload, metabolic acidosis (due to renal failure), and copd. the patient was treated with advair, spiriva, and albuterol and ipratropium nebs. she never required dialysis. the patient's dyspnea improved with bronchodilators and recovery of her kidney function. . # substance abuse/overdose: patient denied intentional overdose. the psychiatry service was consulted and did not feel that the patient was at acute risk for self-harm. clonidine, , , topamax, naltrexone, and cymbalta were stopped. seroquel was decreased to 50 mg nightly. clonzepam was decreased to 1 mg . lidocaine patch was added for pain management. the patient's primary care doctor to make him aware of what has occurred. the patient was instructed to follow up with her psychiatrist. . # hepatitis c: the patient has a history of hepatitis c and iv drug use. it is unclear if she has a history of cirrhosis. . # communication: patient, husband & siblings medications on admission: coumadin (unclear amounts) (approx 80 tabs) clonidine 0.3mg tid prn naltrexone 50mg daily klonopin 1mg tid quetiapine 600mg qhs cymbalta 120mg daily tiotroprium daily topamax 100mg daily advair daily albuterol prn discharge medications: 1. outpatient lab work inr on inr on fax results to dr. , phone 2. outpatient lab work chem 7 and cbc, on fax result to dr. , phone 3. proventil hfa 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours) for 4 weeks. disp:*56 tablet, delayed release (e.c.)(s)* refills:*0* 7. clonazepam 1 mg tablet sig: one (1) tablet po twice a day. 8. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation once a day. 9. quetiapine 50 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*1* 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): place on for 12 hours, then remove for 12 hours. disp:*30 adhesive patch, medicated(s)* refills:*1* 11. warfarin 2.5 mg tablet sig: two (2) tablet po once a day: your doctor may need to adjust your dose. disp:*60 tablet(s)* refills:*0* 12. lovenox 80 mg/0.8 ml syringe sig: one (1) subcutaneous once a day for 5 days. disp:*5 syringes* refills:*1* 13. acetaminophen 325 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for pain: do not take more than 2000mg total per day. discharge disposition: home discharge diagnosis: acute- acute liver failure, secondary to tylenol toxicity acute renal failure due to acute tubular necrosis acute blood loss anemia gastritis chronic- dvt/pe hepatitis c discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital due to liver and kidney failure due to taking too much tylenol and other medications. your liver has recovered. your kidneys are still improving. it is unclear if you will have any lasting kidney damage. you will need to have your kindey function checked next week on wednesday. . you had bleeding from your stomach. your endoscopy showed gastritis. you were placed protonix and sucralfate to treat this. your blood levels are now stable and starting to improve. you will need your blood counts checked on wednesday. . your colonscopy showed a large polyp that should be removed after you have completed your coumadin treatment. . for your history of dvt, you were placed on heparin iv and then transitioned to coumadin. your couamdin level (inr) is not high enough yet, so you were started on lovenox injections. you will need to use this for the next 5 days, once a day. please have your inr checked at your primary care office on monday () and wednesday (). . please keep your follow up appointments. . the following changes were made to your medications. -changed coumadin dose -started on lovenox for 5 days -started on protonix to protect the stomach -started on sucralfate to protect the stomach -stopped topamax -stopped naltrexone -stopped clonidine -stopped cymbalta -stopped -stopped fiorcet -decresed tylenol, do not take more than 2000mg per day -decreased seroquel dose -decreased clonazepam to twice a day -increased advair to twice a day -started on lidocaine patches followup instructions: md: dr. specialty: primary care phone number: please call on monday morning for an appointment to see him this week . please also call your psychiatrist to set up an appoitment to dicuss your medication changes. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances colonoscopy diagnoses: acidosis tobacco use disorder acute kidney failure with lesion of tubular necrosis acute posthemorrhagic anemia acute and subacute necrosis of liver chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma hypopotassemia disorders of phosphorus metabolism long-term (current) use of anticoagulants unspecified gastritis and gastroduodenitis, with hemorrhage personal history of venous thrombosis and embolism hyperosmolality and/or hypernatremia benign neoplasm of colon poisoning by aromatic analgesics, not elsewhere classified bipolar disorder, unspecified other, mixed, or unspecified drug abuse, continuous accidental poisoning by aromatic analgesics, not elsewhere classified 

Answer: The patient is high likely exposed to