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: unresponsive major surgical or invasive procedure: none history of present illness: mr. is a 54 yo man with a pmh of depression, past suicide attempts, htn, etoh abuse with dt's (las drink 1 month ago), and recent acceleration of his ativan use who was transferred from hospital to micu after he was found down by his parents with empty coumadin and lamictal bottles near him. per records, the patient was found the morning of after his parents heard a "thud" and found him lying next to the bottles not responding. he was brought to osh and was found to be minimally responsive. he was intubated and a central line was placed in the ed. head ct there showed small fluid collection abutting the right front lobe not causing mass effect, density suggests subacute subdural hematoma. head ct there showed small fluid collection abutting the right front lobe not causing mass effect, density suggests subacute subdural hematoma. ct c-spine showed postop changes c5-7 otherwise no fractures. inr was 1.8, ptt 38. tox screen was negative for acetaminophen, salicylates or alcohol. he was given 10 units iv vitamin k for the concern for coumadin o/d & transferred to for further management/neurosurgery evaluation. past medical history: depression, prior sa bilateral dvt's on coumadin htn subdural hygroma s/p c5-7 fusion social history: etoh abuse - drank about gallon of vodka/day, now abstinent denies tobacco or illicit/recreational drugs. divorced with two children. family history: non-contributary physical exam: gen:intubated and sedated skin:erythema over left forearm, soft heent:pupils equal and reactive, et tube in place, ng tube in place chest:lungs are clear without wheeze, rales, or rhonchi. cardiac: regular rhythm; no murmurs, rubs, or gallops. abdomen: no apparent scars. non-distended, and soft without tenderness extremities:swelling/ecchymosis over right foot neurologic: sedated exam off sedation: pt responds to commands, opens eyes, squeezes hands, and has jerky motion of both lower extremities but responding throughout this jerking motion pertinent results: admission labs: 06:02pm type-art rates-/14 peep-5 po2-324* pco2-44 ph-7.40 total co2-28 base xs-2 intubated-intubated vent-controlled 06:02pm glucose-138* lactate-2.4* na+-140 k+-3.5 cl--101 tco2-28 06:02pm freeca-1.20 06:00pm glucose-136* urea n-10 creat-0.8 sodium-143 potassium-3.6 chloride-103 06:00pm alt(sgpt)-255* ast(sgot)-119* ck(cpk)-168 alk phos-135* tot bili-0.8 06:00pm lipase-25 head ct: impressions: 1. 8-mm subacute right frontal subdural collection, without evidence of acute bleeding. no area of acute intracranial hemorrhage. 2. mild atrophy of left temporal lobe. 3. paranasal sinus disease with fluid in the sphenoid sinuses likely related to intubation. chest ct : impressions: 1. left lower lobe consolidation may represent atelectasis, infection, or aspiration. small right lower lobe ill-defined nodules also suggest aspiration. 2. no traumatic injuries within the torso. no fractures. 3. diverticulosis without diverticulitis. ct spine impressions : 1. no fracture or malalignment of the cervical spine. 2. status post c5 through c7 fixation and laminectomies without evidence of hardware complication. head mri : impression: no acute infarct seen. unchanged right frontal subdural. soft tissue changes in the left frontal sinus and sphenoid sinus. mri spine : impression: new enhancement and increased signal in the posterior soft tissues with a 1.5- cm fluid collection near the tip of the spinous process of t1 could be due to trauma or due to new inflammatory changes. infection should be excluded by clinical correlation. findings were discussed with dr. at the time of interpretation of the study on . no epidural abscess or cord compression seen. foot ap/lat: three views of the right foot: there is no fracture or dislocation. no focal lytic or sclerotic osseous abnormality is visualized. no radiopaque foreign bodies are present. there are no soft tissue calcifications. no focal lytic or sclerotic osseous abnormalities are present. joint spaces are relatively preserved. impression: no fracture or dislocation. chest x ray : findings: ap single view of the chest has been obtained with patient in sitting semi-upright position. comparison is made with the next previous similar study obtained 14 hours earlier during the same date. position of ng tube and left-sided subclavian central venous line unchanged as described earlier. inspiration status markedly improved. the left-sided retrocardiac diffuse density seen on the previous study has now cleared up. one can identify a plate atelectasis, but as the left-sided diaphragm is well described, significant pleural effusion and parenchymal infiltrate in this area is most unlikely. no pneumothorax has developed. pulmonary vasculature is not congested. impression: improvement of previously identified left lower lobe atelectasis in patient with suspected overdose and previous respiratory failure. emg : impression: complex, abnormal study. the electrophysiologic findings can be explained most parsimoniously by a severe, subacute (between 3 weeks to 3 months) c7-t1 polyradiculopathy on the right. the findings cannot be explained by a posterior interosseous neuropathy in isolation. the preservation of the medial antebrachial cutaneous response on the right makes a brachial plexopathy effecting the lower trunk unlikely. there is also evidence for an underlying, mild, chronic c5-7 radiculopathy on the right. of note, axonal continuity is maintained to all muscles tested. if clinically indicated, repeat testing in three months may be warranted. brief hospital course: 54 yo m found down at home, intubated in ed for unresponsiveness after coumadin and lamictal overdose . # unresponsiveness /fall: in the ed, vital signs were initially were 99 146/89 hr 86 rr 16 100% the patient was intubated. he had ct head which showed right frontal lobe area concerning for a subdural hematoma. neurosurgery felt that the ct head changes were related to post surgical status, and no acute intervention was needed. ct torso showed lll infiltrate concerning for aspiratin pneumonia; thus pt given vanc/zosyn. xray of right foot done for swelling noted on exam which was negative for fracture. labs remarkable for abg 7.40/44/324, inr 1.7, lactate 2.4, wbc 12.4, trop <0.01, creatinine 0.8. ekg with twi and st depression v4-v6 that resolved on repeat. the patient was admitted to the micu where the intitial differential also included lamictal and coumadin overdose, seizure vs etoh withdrawal vs arrhythmia (given the ekg changes noted in ed that later resolved) vs pe (the patient was subtherapeutic on coumadin on arrival) vs wernickes encephalopathy. on arrival to the micu he was responding to commands with lightened sedation but with clonus and hyperreflexia (not thought to be new but possibly be more pronounced than previously described on omr notes). while he was being examined by the micu team off propofol, he started having rhythmic jerky movements in all limbs, and neuro was called for concerns of seizures. they noted that the patient was able to stop the movement for few secs if instructed and was able to follow commands during these movements. it was thought that the patient was exhibiting clonus due to toxic metabolic encephalopathy due to multi medication overdose (lamictal and coumadin) or withdrawal (alcohol vs benzodiazepines). . when the patient was awake to be able to give a history it was determined that the patient has a history of alcohol abuse with dts in the past. however, he stated he has not had alcohol in over a month. the patien's sister corroborated this story telling the neurology team that the patient was in a supervised setting post op in his father's home with sister's assistance and no alcohol available. she did, however, think that he used his anti-anxiety and narcotics rx at an "accelerated rate" and overdosed in part due to despondence over pain/restrictive environment. he is normally prescribed 1.5 mg ativan a day. in light of this information, it was thought that the patient might be exhibiting withdrawal not from alcohol but from benzodiazepines so he was started on a ciwa scale with valium. his mental status improved considerably with this regimen. the patient was also evaluated by psychiatry who did not elicit suicidal ideation. the patient told the team that he took pills of warfarin w/lamotrigine because he "wanted to go to sleep." however, in talking with the patient's father, he stated that he feels that his son is not safe to go home and may actually be a danger to himself. therefore, psych determined that the patient should be section 12 with a 1:1 sitter. the pateint was deemed stable for the medicine floor and was transferred. there he continued to improve, with no disorientation. he was alert with good concentration. he was maintained on ciwa scale but only required 2 doses of diazepam for anxiety. he did not score above 10 on the ciwa scale. he was maintained on telemetry and had a few episodes of tachycardia to the 150s which was thought to be normal sinus rhythm. because this only happened when he was getting up from bed and walking it was thought that he was orthostatic and deconditioned from lying in bed for so long. he was hydrated with iv fluids and orthostatics were checked and were negative. he was encouraged to walk around 3 times a day each day. # suicide attempt: as stated above the patient denied suicide attempt with the overdose, but rather states he was just trying to make himself go to sleep by taking all of the medications. he was evaluated by psych who also talked to the patient's father who thought the patient would be a danger to himself at home. for this reason and the fact that the patient has prior suicide attempts he was made section 12 and kept a 1:1 sitter. his fluoxetine was restarted at 60 mg a day on but no other psychiatric medications were restarted. tsh was checked and was normal at 3.1. the patient was discharged to an inpatient pschiatric facility. . # subderual hematoma/hygroma: the patient has a chronic right frontal hygroma and was evaluated by neurosurgery who felt that this was resolving and no intervention was needed. they also felt that there was no contraindication to coumadin. per neurosurgery, the patient will need a follow-up head ct as an outpatient in 4 weeks (end of ). he should call and hit extension #1 to book this appointment. he should follow up with neurosurgery after he gets this ct. he can call the following number to schedule this appointment: (. . # pulmonary infiltrate: ct chest showed evidence of aspiration pna. the patient was afebrile but initially had a mild leukocytosis so he was given vanc/zosyn for 3 days. antibiotics were stopped because the patient was not exhibiting symptoms and was afebrile. he continued to not have any symptoms of pneumonia including shortness of breath, cough, chest pain, or fever. . # dvt's: the patient had bilateral lower extremity dvts diagnosed at a recent admission, for which he was discharged on coumdain. after his overdose on coumadin he was given 10 mg iv vitamin k at the osh. during this hospitalization his initial inr was 1.7 so his coumadin was held. his inr trended down to 1.0. neurosurgery felt that it was ok to restart his coumadin so the patient was bridged with lovenox . his inr remained at 1.0 for several days so his coumadin dose was increased to 10 mg for two days before titrating back to 4 mg a day. the day of discharge his inr was 1.4. the patient should continue to get 4 mg (his home dose) coumadin and have his inr checked every day until he is theraputic (inr ). at that time he can discontinue the lovenox injections. . # right hand palsy: the patient was noted to have a right hand palsy where he was unable to extend his right fingers. it was recommenced by dr. , his neurosurgeon, that he get an emg study. the findings of this study were: "complex, abnormal study. the electrophysiologic findings can be explained most parsimoniously by a severe, subacute (between 3 weeks to 3 months) c7-t1 polyradiculopathy on the right. the findings cannot be explained by a posterior interosseous neuropathy in isolation." neurology recommended that the patient follow up with dr. , w. and have a repeat emg in three months. the patient can call ( to schedule the follow up appointment and ( to schedule the emg study. the patient was evaluated by occupational therapy who priovided a daytime and a nighttime splint which he should continue to wear. the patient noted subjective improvement of his wrist extension, but no improvement of his finger extension the day of discharge. medications on admission: medications at home: (per omr d/c summary/osh notes) senna 8.6 mg prn docusate 100mg prn lamotrigine 75 mg famotidine 20 mg q12h thiamine 100 mg multivitamin folic acid 1 mg fluoxetine 60 mg dulcolax 10 mg suppository prn acetaminophen 650 mg prn warfarin 4 mg qd oxycodone 5mg q6 prn discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po once a day as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 3. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. dulcolax 10 mg suppository sig: one (1) rectal once a day. 8. oxycodone 5 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for arm pain. 9. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 10. fluoxetine 20 mg capsule sig: three (3) capsule po daily (daily). 11. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: lamictal overdose coumadin overdose secondary diagnosis: subdural hematoma depression bilateral dvts discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you came to the hospital after you were found down on the ground. you told us that you overdosed on lamictal and coumadin. you were intubated and monitored in the intensive care unit. we gave you medicines to treat you for benzodiazepine withdrawal and supportive measures until the medications you overdosed on cleared from your system. you were evaluated by the neurosurgeons who thought that your head did not have evidence of bleeding. they would like you to follow up with a repeat head ct in 4 weeks and see them in outpatient clinic. you can call to schedule these appointments (see below). you were also evaluated by the psychiatrists who thought that you might be in danger of hurting yourself. they think you would benefit from inpatient psychiatric treatment. please follow their recommendations regarding restarting your medications for depression, some of which we have held during this hospitalization. you were also noted to have a right hand paralysis that you first noticed after your initial fall back in . you had an emg study performed which showed some abnormailities in the nerves in your arm. the neurologists would like you to follow up with them and have a repeat emg in 3 months. please see below for the numbers to call to schedule these appointments. you were also seen by occupational therapy who stated you should wear a resting splint when you sleep as well as a dyamic brace during the day when you are doing activities. we restarted you back on your blood thinners for your blood clot in your legs. you should continue to take both the lovenox shots twice a day as well as the coumadin once a day and have your blood drawn every day until your inr level is theraputic (between 2 and 3). at that time you can stop the lovenox shots and just continue with the coumadin. pleas note the following changes to your medications: please stop lamictal please stop fluoxetine please change your oxycodone to 10 mg every 4 hours as needed for arm, neck, shoulder pain please continue lovenox 60 mg twice a day until your inr is between 2 and 3. please continue to take the rest of your medications as prescribed. it was a pleasure taking part in your care. followup instructions: to evaluate your subdural hematoma you will need to get another head ct in a few weeks (mid ) and then follow up with the neurosurgeon, dr. . in order to schedule the head ct you should call and hit extension #1. you can then call the following number to schedule the appointment with dr. : (. you will also need to have a repeat emg study and follow up with a neurologist for your right hand palsy. please call ( to schedule the emg study (in mid ). please call ( to schedule the follow up appointment with dr. , in neurology for an appointment after you get the emg study. please follow up with your primary care doctor after you are discharged from for a post hospitalization check up. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnoses: toxic encephalopathy unspecified essential hypertension depressive disorder, not elsewhere classified alcohol abuse, unspecified anxiety state, unspecified pneumonitis due to inhalation of food or vomitus long-term (current) use of anticoagulants personal history of venous thrombosis and embolism subdural hemorrhage leukocytosis, unspecified poisoning by other and unspecified anticonvulsants suicide and self-inflicted poisoning by other specified drugs and medicinal substances other alteration of consciousness nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] poisoning by anticoagulants mononeuritis of upper limb, unspecified 

Answer: The patient is high likely exposed to