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: altered mental status polysubstance ingestion acetaminophen toxicity major surgical or invasive procedure: intubation history of present illness: 50 yo f with hx of psychiatric disease, s/p polyingestion, found by family to be agitated and sent to osh where became obtunded and apneic. was febrile to 101.1, hypotensive so given 2l and started on levophed. given vancomycin and ceftriaxone and blood cultures sent. femoral line placed. unable to intubate. tylenol level was 274, asa 8.6, inr 1.36, cr 1.8, glu 149, hct 35. patient developed hypotension and bradycardia. given ctx, nac loading dose of 8951mg at 002, fentanyl/versed and transfered via med flight. . in the ed, ekg showed sr 45, na qtc 538, twf v2-v3. intubated with significaint aiway edema. 700 cc ivf given. continued fentanyl/versed, given mag 2g, nac ordered, pads on. labs showed wbc 12.4, hct 29, platelets 348 with inr 1.5, ptt 21.2, fibrinogen 181. ua negative except >80 ketones. tox positive for benzo and opiates. . she was given propofol, midazolam, fentanyl and norepi initially but had been off for a half-hour prior to transfer to the floor. blood culture was sent and cxr was done. . toxicology and liver were consulted. vs on transfer: 98.4, 54, 118/91, 18, 100% on 500/18/5/100% abg shows 7.39/35/530. triple lumen, 18, 20gs for access. . prior to transfer, bps dropped and hrs decreased to 40s. started on levophed .03 and given 1mg atropine and now vs: 84, 172/101. labs showed k 2.9, ag18, creatinine 1.3, lactate 1.5. calcium 7.4, elevated lipase, ast/alt, ldh. wbc 12.4, hct 29 (from 35 osh), 348. inr 1.5. . on the floor, she is intubated and sedated. past medical history: depression, anxiety, complex regional pain syndrome (left leg), ibs/constipation/hemmorhoids, tmj, ddd thoracic spine, hl, abusive home situation, ulcerative proctitis social history: remote history of etoh abuse. per husbnad, has not had a drink in years. per psych, history of domestic abuse. family history: unknown physical exam: admission pe: vitals: 96.3 62 138/93 18 100% general: sedated. blood oozing from ocerners of mouth. arousable to light touch heent: sclera anicteric, mmm, oropharynx with dry blood on roof of mouth neck: supple, jvp not elevated lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place draining clear fluid ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge pe: vitals: tc 98.4, tm 98.9, bp 127/87, hr 74, rr 16, 100%ra general: depressed middle aged woman, but responding to questions appropriately, interacting, with less psychomotor retardation. heent: perrl, eomi, sclera anicteric, mmm, clear oropharynx lungs: clear to auscultation bilaterally, no wheezes, ronchi. few rales at bases. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-distended, minimally tender to palpation on the left, normoactive bowel sounds, no rebound tenderness or guarding, no organomegaly on palpation, no masses ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: cbc: 02:40am blood wbc-12.4* rbc-3.63* hgb-9.8* hct-29.0* mcv-80* mch-27.0 mchc-33.8 rdw-14.4 plt ct-348 06:03am blood wbc-9.8 rbc-3.49* hgb-9.4* hct-27.9* mcv-80* mch-26.8* mchc-33.5 rdw-14.4 plt ct-321 11:57am blood wbc-9.7 rbc-3.59* hgb-9.8* hct-28.9* mcv-81* mch-27.5 mchc-34.0 rdw-14.6 plt ct-365 05:38pm blood wbc-10.2 rbc-3.54* hgb-9.5* hct-28.8* mcv-81* mch-26.8* mchc-33.0 rdw-14.6 plt ct-338 05:37am blood wbc-11.5* rbc-4.12* hgb-11.1* hct-33.6* mcv-82 mch-26.9* mchc-32.9 rdw-14.6 plt ct-422 02:40pm blood wbc-14.1* rbc-4.20 hgb-11.2* hct-33.6* mcv-80* mch-26.7* mchc-33.5 rdw-14.6 plt ct-490* 03:42am blood wbc-10.7 rbc-3.71* hgb-10.0* hct-29.6* mcv-80* mch-27.1 mchc-34.0 rdw-14.6 plt ct-397 01:19am blood wbc-7.2 rbc-3.53* hgb-9.4* hct-28.1* mcv-80* mch-26.8* mchc-33.6 rdw-14.6 plt ct-330 09:45am blood wbc-5.2 rbc-4.18* hgb-11.1* hct-33.3* mcv-80* mch-26.4* mchc-33.2 rdw-15.0 plt ct-385 coags: 02:40am blood pt-17.1* ptt-21.2* inr(pt)-1.5* 06:03am blood pt-18.4* ptt-24.9 inr(pt)-1.7* 11:57am blood pt-18.7* ptt-24.1 inr(pt)-1.7* 05:38pm blood pt-19.2* ptt-25.9 inr(pt)-1.7* 12:00am blood pt-18.7* ptt-25.5 inr(pt)-1.7* 05:37am blood pt-17.6* ptt-24.7 inr(pt)-1.6* 02:40pm blood pt-17.2* ptt-24.0 inr(pt)-1.5* 09:35pm blood pt-17.0* ptt-24.3 inr(pt)-1.5* 03:42am blood pt-16.2* ptt-23.3 inr(pt)-1.4* 04:43pm blood pt-15.5* ptt-23.1 inr(pt)-1.4* 01:19am blood pt-15.5* ptt-21.7* inr(pt)-1.4* 09:45am blood pt-14.5* ptt-21.3* inr(pt)-1.2* fibrinogen: 02:40am blood fibrino-181 chem 7: 02:40am blood glucose-200* urean-19 creat-1.3* na-142 k-2.9* cl-103 hco3-21* angap-21* 06:03am blood glucose-162* urean-17 creat-1.0 na-140 k-3.1* cl-108 hco3-19* angap-16 11:57am blood glucose-74 urean-18 creat-0.9 na-140 k-4.1 cl-109* hco3-20* angap-15 05:38pm blood glucose-107* urean-19 creat-0.8 na-140 k-3.7 cl-110* hco3-19* angap-15 12:00am blood urean-18 creat-0.7 na-141 k-3.6 cl-108 hco3-20* angap-17 05:37am blood glucose-106* urean-17 creat-0.8 na-141 k-3.6 cl-106 hco3-21* angap-18 02:40pm blood glucose-132* urean-15 creat-0.7 na-142 k-3.6 cl-103 hco3-24 angap-19 09:35pm blood glucose-148* urean-15 creat-0.7 na-141 k-4.4 cl-107 hco3-25 angap-13 03:42am blood glucose-172* urean-15 creat-0.7 na-139 k-4.0 cl-103 hco3-25 angap-15 04:43pm blood urean-9 creat-0.7 na-141 k-3.9 cl-103 hco3-26 angap-16 01:19am blood glucose-128* urean-12 creat-0.8 na-142 k-4.0 cl-106 hco3-27 angap-13 09:45am blood glucose-238* urean-8 creat-0.7 na-140 k-3.2* cl-99 hco3-26 angap-18 lfts: 02:40am blood alt-130* ast-146* ld(ldh)-308* alkphos-48 totbili-0.7 06:03am blood alt-116* ast-132* ld(ldh)-302* alkphos-43 totbili-0.8 11:57am blood alt-127* ast-122* ld(ldh)-275* alkphos-46 totbili-1.2 05:38pm blood alt-150* ast-136* alkphos-45 totbili-1.0 12:00am blood alt-291* ast-261* ld(ldh)-377* alkphos-50 totbili-0.9 05:37am blood ast-411* alkphos-53 totbili-0.8 02:40pm blood alt-1216* ast-1192* alkphos-62 totbili-0.9 09:35pm blood alt-1601* ast-1555* alkphos-52 totbili-0.7 03:42am blood alt-* ast-1477* ld(ldh)-1339* alkphos-57 totbili-1.0 04:43pm blood alt-1810* ast-812* ld(ldh)-816* alkphos-51 totbili-0.9 01:19am blood alt-1530* ast-522* ld(ldh)-566* alkphos-48 totbili-0.9 10:00am blood alt-1389* ast-367* ld(ldh)-386* alkphos-49 totbili-0.9 09:45am blood alt-1052* ast-136* ld(ldh)-259* alkphos-58 totbili-0.9 lipase: 02:40am blood lipase-398* 05:38pm blood lipase-124* 05:37am blood lipase-95* 03:42am blood lipase-246* ca+, mg, phos: 02:40am blood albumin-3.9 calcium-7.4* phos-5.0* mg-2.3 06:03am blood albumin-3.4* calcium-7.4* phos-4.3 mg-2.8* 11:57am blood albumin-3.6 calcium-8.8 phos-3.3 mg-2.5 05:38pm blood albumin-3.4* calcium-8.4 phos-2.9 mg-2.0 12:00am blood calcium-8.4 phos-4.0 mg-1.8 05:37am blood albumin-3.8 calcium-8.8 phos-3.9 mg-1.8 02:40pm blood calcium-9.6 phos-1.1*# mg-2.0 09:35pm blood calcium-8.6 phos-1.1* mg-2.0 03:42am blood calcium-9.2 phos-2.1* mg-2.0 04:43pm blood calcium-9.0 phos-2.3* mg-1.9 01:19am blood calcium-8.8 phos-2.8 mg-2.0 anemia w/u: iron 25 (low) 10:00am blood caltibc-398 vitb12-> folate->20.0 ferritn-102 trf-306 other labs: 02:40am blood osmolal-295 05:38pm blood hbsag-negative hbsab-positive hbcab-negative igm hav-negative 05:38pm blood smooth-negative 05:38pm blood -negative 05:38pm blood asa-neg 02:40am blood asa-8.0 ethanol-neg acetmnp-183* bnzodzp-neg barbitr-neg tricycl-neg 05:38pm blood hcv ab-negative blood gas: 02:52am blood type- po2-68* pco2-47* ph-7.29* caltco2-24 base xs--3 comment-green top 03:35am blood type-art temp-36.3 po2-530* pco2-35 ph-7.39 caltco2-22 base xs--2 intubat-intubated 12:20pm blood type-central ve po2-169* pco2-42 ph-7.32* caltco2-23 base xs--4 comment-green top 07:15pm blood type-art rates-/10 tidal v-500 peep-5 po2-220* pco2-33* ph-7.38 caltco2-20* base xs--4 intubat-intubated vent-spontaneou lactate: 03:35am blood lactate-1.5 12:20pm blood lactate-1.1 07:15pm blood lactate-0.6 urine: 02:40am urine color-yellow appear-clear sp -1.020 06:03am urine color-yellow appear-clear sp -1.022 04:14pm urine color-straw appear-clear sp -1.002 02:40am urine blood-neg nitrite-neg protein-neg glucose-neg ketone->80 bilirub-neg urobiln-0.2 ph-5.0 leuks-neg 06:03am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-40 bilirub-neg urobiln-neg ph-5.5 leuks-neg 04:14pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 06:03am urine eos-negative 06:03am urine hours-random creat-55 na-79 k-67 cl-39 06:03am urine osmolal-558 02:40am urine bnzodzp-pos barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg microbiology: urine cultures negative, mrsa screen negative, blood cultures ngtd imaging: ecg: rate 43, sinus bradycardia. the q-t interval is prolonged. there are non-diagnostic q waves in the inferior leads. no previous tracing available for comparison. ecg: rate 47, sinus bradycardia. the q-t interval is prolonged. there are non-diagnostic q waves in the inferior leads. compared to the previous tracing of the same day the rate is shorter. cxr: standard positioning of et tube. ecg: rate 67, normal sinus rhythm. tracing is within normal limits. compared to the previous tracing of , except for an increase in rate from 47 to 67 beats per minute and the normal q-t interval on the current tracing, there is no diagnostic interval change. head ct w/o contrast: no acute intracranial process. upper extremity doppler: no evidence of right upper extremity dvt. ruq us: 1. normal echotexture to the liver. spleen is normal in size. no ascites. no ultrasound signs of portal hypertension. 2. gallbladder wall is mildly thickened. while possibly in part due to underdistention, this is may be due also in part to acute hepatitis from the tylenol overdose. brief hospital course: 50 yo f with history of depression with psychotic features presents with altered mental status, bradycardia and hypotension in the setting of polysubstance overdose, namely acetaminophen toxicity. . # shock: most likely due to multiple drug overdose, particuarly likely due to antihypertensive and betablocker toxicity. could also be from narcotics. less likely sepsis - afebrile, no elevated wbc, clear cxr, neg ua. cardiogenic possible with bradycardia causing low stroke volume. hemorrhage less likely though given hct drop and elevated inr, still in differential. no evidence of active bleeding. her bp stabilized during her stay in the micu with administration of fluids. no vasopressor support was needed once in the icu. once effects of betablocker toxicity abated, she was hemodynamically stable. . # bradycardia: differential includes medication effect including beta-blocker toxicity. got glucagon at osh for suspected beta blocker toxicity, and atropine at . patient's hr increased only from 40 to 45 with atropine 0.5mg and bp remained in sbps mid 90s. she did not require glucagon or dopamine for support while at . . # tylenol overdose: at osh, tylenol level was 274. at their peak, lfts were: alt , ast 1477, ldh 1339, inr 1.7. patient with elevated inr suggesting hepatic dysfunction. she was nac loaded at osh and continued on nac during course of admission, until ast and alt decreased below 1000. initally, lfts and synthetic function peaked and nac was temporarily discontinued but restarted when lfts continued to peak. hepatology and toxicology were following patient. lfts and inr monitored twice daily. hepatitis titers negative (vaccinated for hbv), and anti-smooth muscle ab negative. lfts declined over the course of the admission, nac was discontinued when alt < 1000. lfts at the time of discharge were alt 437 ast 33. patient's psych medications were temporarily held during admission, as most are hepatically cleared. haldol was given for agitation once ast/alt<1000. . # alcohol abuse: concern that tachycardia, hypertension, and low grade temperature in addition to psychomotor agitaton was related to acute alcohol withdrawal. she refused to elaborate on prior etoh abuse history or provide details regarding any recent use. she was monitored on ciwa scale and low dose lorazepam 0.5mg administration, which she did not have significant requirement. subsequently, husband relayed that patient has not been known to drink for the past several years. ciwa was discontinued. ruq us did not show evidence of cirrhosis. . # low grade fever (100.7): occurred in context of drug toxicity and acute liver injury. patient was started on empiric antibiotics (vancomycin/zosyn) from which were discontinued . blood cultures ngtd and urine cultures negative. patient remained afebrile on the medicine wards. . # mental status change: intubated and sedated on admission for obtundation, improved with time. likely due to intoxication from narcotics (+opiod and benzo on tox screen) as well as encephalopathy tylenol overdose. possibly due to serotonin syndrome. per toxicology, no role for cyproheptadine as other anticholinergics taken. pt at times very agitated which could related to etoh withdrawal (though husband denies current etoh use) vs anxiety. steroids discontinued. patient is clinically depressed and minimally interactive, however displays evidence of delerium, with waxing and agitation (requiring haldol and 4point restraints at one point), which could be a result of the change in environment and recent toxicities and icu stay with intubation. patient has no electrolyte abnormalities or signs of infection. tsh,b12 were wnl. hiv negative. rpr was pending at time of discharge. unclear if intentionally overdose of medications per patient and husband recollection. pt maintained profound "confusion" regarding incident, but became relatively more clear and cooperative over the course of her hospitalization. psychiatry was consulted and recommended admission to inpatient psychiatric facility. . # depression with psychosis: patient severely depressed, with psychomotor retardation, hallucinations and paranoia (per husband). not currently on psych medications given liver damage. will be transferred to psych unit for further management. . # anemia/hct drop: patient with 6 point hct drop from osh, possibly from dilution, given ivf administration. stabilized. no signs of active bleeding. iron low at 25. b12 wnl. folate wnl. started on iron supplements. will need outpatient colonoscopy as outpatient. . # hypertension: patient was hypertensive off home medications. pressures managed on carvedilol and home chlorthalidone. . # prolonged qtc: resolved. prolonged on admission, thought to be citalopram related, but could also have had beta blocker toxicity. initially, she was given magnesium and monitored with q2 fingersticks which were decreased in frequency once stabilized. conitued to be monitored with addition of standing haldol but qtc remained < 400. . # constipation: patient was having trouble with bowel movements during hospitalization, and some diffuse abdominal pain. additionally, iron supplements were added to regimen given iron deficiency. given miralax as an inpatient. can be managed with senna and colace as an outpatient. . # communication: patient, husband # code status: full code, per hcp husband . transitional issues: patient is clinically depressed with associated psychotic symptoms. she has a very poor understanding of her condition and is overwhelmed. she will need close follow up and psychiatric treatment, which an inpatient psychiatric unit can provide. she will also need lfts trended as an outpatient by her primary care, will possibly need hepatology follow up if persistently elevated. pt requires outpatient colonoscopy to evaluate for anemia. qtc should also be monitored if there will be significant increases to her antipsychotic regiemen. medications on admission: , resolution of pschosis with zyprexa. per pcp note dated : ibuprofen 600mg tid, tramadol 50mg q6hrs prn for pain, chlorthalidone 25mg qdaily, citalopram 20mg qdaily, prednisone 10mg with food or milk 4,4,4,3,2,1; metoprolol succinate 50mg er qdaily, tizanidine 4mg prn q8hrs, gabapentin 100mg tid (per bottles family broght in) alprazolam 1 mg tab oral 1 tablet(s) every 6 hrs, as needed . citalopram 20 mg tab oral 1 tablet(s) once daily . hydroxyzine pamoate 50 mg cap oral 1 capsule(s) four times daily, as needed . sertraline 50 mg tab oral 1 tablet(s) once daily in am . gabapentin 300 mg tab oral 2 tablet(s) three times daily . tizanidine 4 mg tab oral 3 tablet(s) every 8 hrs . tramadol 50 mg tab oral 1 tablet(s) every 4hrs, as needed . hydrocodone-acetaminophen 10 mg-660 mg tab oral 1 tablet(s) every 6 hrs, as needed . gabapentin 100 mg tab oral 1 tablet(s) three times daily . amitiza 24 mcg cap oral (lubiprostone) 1 capsule(s) twice daily . ranitidine 150 mg tab oral 1 tablet(s) twice daily for 5 days while on prednisone . metoprolol succinate er 50 mg 24 hr tab oral 1 tablet extended release 24 hr(s) once daily . metoprolol succinate er 25 mg 24 hr tab oral 1 tablet extended release 24 hr(s) once daily . cymbalta 60 mg cap oral 1 capsule, delayed release(e.c.)(s) once daily . chlorthalidone 25 mg tab oral 1 tablet(s) once daily discharge medications: 1. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 2. chlorthalidone 25 mg tablet sig: one (1) tablet po daily (daily). 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po twice a day. 5. colace 50 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 6. outpatient lab work recheck labs (inr and lfts: ast, alt, ldh, tbili, alk phos) 1 week after discharge and fax results to dr. , fax #, phone #. discharge disposition: extended care discharge diagnosis: primary diagnosis: polyingestion, acetaminophen toxicity depression with psychotic features secondary diagnosis depression, anxiety, complex regional pain syndrome (left leg), ibs/constipation/hemmorhoids, tmj, ddd thoracic spine, hl, abusive home situation, ulcerative proctitis discharge condition: mental status: clear and coherent, but severely depressed with psychomotor retardation. level of consciousness: alert but minimally interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital because you had ingested many of your home medications and you became drowsy and confused. because of the toxic ingestion, you required a breathing tube, as you were no longer breathing safely on your own. there was a very high level of tylenol in your blood (which is contained in vicodin). your labs showed signs of liver damage from the tylenol. we gave you medication to treat the high levels of tylenol and we monitored your labs to make sure they were returning to normal. with time, your were able to clear the toxins out of your system. the breathing tube was removed and you were able to breathe on your own again. psychiatry was following you closely and now that your labs have returned to , they are recommending you be trasnferred to a facility that can help treat your depression. the following changes were made to your medication regimen: all medications were stopped except chlorthalidone 25mg orally daily. continue chlorthalidone 25mg orally daily. start carvedilol 6.25mg orally twice a day. start iron supplements twice a day. take senna and colace for constipation if needed. the facility where you are being transferred to will manage your depression and other medications. followup instructions: the psychiatry facility where you are being transferred will coordinate your care. you will need follow up labs to make sure all your labs are back to normal. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified acute kidney failure, unspecified depressive disorder, not elsewhere classified hypopotassemia constipation, unspecified acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified drug-induced delirium poisoning by aromatic analgesics, not elsewhere classified home accidents nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] nonspecific abnormal electrocardiogram [ecg] [ekg] unspecified psychosis accidental poisoning by aromatic analgesics, not elsewhere classified 

Answer: The patient is high likely exposed to