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: "lethargy." major surgical or invasive procedure: intubation/extubation history of present illness: patient is a 50 m with a past history of diabetes, chronic lower leg pain, copd, obesity-related hypoventilation syndrome, past history of respiratory failure, chronic pain on opiates, dmii who presents with decreasing and fluctuating mental status per his mother. is also complaining of leg pain and weakness that is similar to prior. he has been feeling somewhat more short of breath particularly with exertion. he is using his albuterol and ipratroprium inhalers slightly more than baseline. he also states that he has had some non-productive cough, chills but no fevers. his mother controls his medications, and she is fairly certain that he has not overdosed on his pills. in the ed, his initial vs were 97.5 116 146/81 8 100% ra. he then triggered for hypoxia to 88% on ra. his exam was significant for lethargy, moving all extremities but not compliant with full neuro exam drowsiness. he had wheezing on pulmonary exam. his abg showed pco2 63. lactate 1.4. tox screen was positive for benzos. his ekg showed sinus 116, nani, no ste. cxr showed lll infiltrate and he was given levoquin. he was also given solumedrol and azithro for copd flare. vitals prior to transfer: p 94, 140/82, o2 sat 93% on 4 l via bipap . on arrival to the micu, patient was requesting food. past medical history: - type 2 dm has been followed at (last a1c 8.0 ) - osa on cpap at home - hepatits c - s/p aborted course of interferon - major depressive disorder, ? of schizophrenia and bipolar disorder - hypertension - bilateral avascular necrosis of femoral heads s/p hip replacements in ' and ' - s/p l1/l2 kyphoplasty after fall - s/p left distal radius fracture after fall - bilateral lower extremity edema, thought to be secondary to venous stasis - djd of his back - osteoporosis - morbid obesity - schatski's ring social history: on disability, lives with his mother, attends a day program. - tobacco: smokes ppd for > 10yrs - alcohol: no etoh for 15 years - illicits: stopped ivda in after 3 years of use, did take cocaine with heroine. has not used since then. family history: father with dm and cad physical exam: vitals: t: 97.2 bp: 160/72 p: 106 r: 17 o2: 94% on 2l nc general: obese, aaox3, closes eyes during interview but easily arousable heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: diminished breath sounds throughout, no wheezes, rales, ronchi abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: hypertrophic toenails neuro: cnii-xii intact, moving all extremities, 3/5 strength in le limited by pain, sensation intact throughout discharge pe: general: obese, flat affect, in nad heent: cn 2-12 grossly intact, mmm cv: distant hs, rrr, no rmg lungs: ctab, no wrr, distant bs abdomen: obese, soft, ntnd, bowel sounds present extremities: decreased strength in hip flexion and extension and knee extension/flexion 4+/5 and ankle plantar flexion and extension 4+/5, sensation in grossly intact pertinent results: admission: 11:30am blood wbc-4.5 rbc-3.88* hgb-12.1* hct-37.1* mcv-96 mch-31.2 mchc-32.7 rdw-13.9 plt ct-127* 11:30am blood neuts-69.1 lymphs-21.7 monos-6.6 eos-2.1 baso-0.4 11:30am blood glucose-161* urean-33* creat-1.0 na-135 k-4.9 cl-99 hco3-29 angap-12 11:30am blood calcium-9.0 phos-4.4 mg-1.5* 01:09pm blood type-art po2-109* pco2-59* ph-7.34* caltco2-33* base xs-4 comment-green top 11:48am blood glucose-150* lactate-1.4 discharge: 06:10am blood wbc-5.5 rbc-3.86* hgb-11.9* hct-35.2* mcv-91 mch-30.9 mchc-33.9 rdw-13.9 plt ct-139* 06:00am blood glucose-327* urean-23* creat-0.9 na-134 k-4.4 cl-93* hco3-32 angap-13 06:00am blood calcium-9.6 phos-4.1 mg-1.6 cxr impression: mild pulmonary edema. repeat imaging after diuresis is recommended to evaluate for concomitant pneumonia. echo impression: suboptimal image quality. normal global and regional biventricular function. mildly dilated aortic arch. mild pulmonary artery hypertension. brief hospital course: 50m with h/o osa, copd and chronic pain on narcotics, who was admitted with hypercarbic respiratory failure. #. ams: patient presented with increased lethargy for week. he was oriented on arrival to the micu but was falling asleep intermittently during the interview. patient had been taking seroquel 600 mg po qhs and xanax 4 mg po bid, oxycontin sr 100 mg po tid, oxycodone ir 10 mg po q3-4h which are likely contributing to his ams. he has not been taking risperdal. held all pysch meds while lethargic discontinued seroquel. decreased xanax dose and continue lower dose seroquel once more awake. treated medical comorbities as below. his ams improved and he was transferred to the floor. his ams was thought to be multifactorial. his bipap settings were adjusted, psych was consulted and adjusted his medications to seroquel 300mg po daily, risperidone 3mg daily and diazepam 1mg po qid. pain was also consulted and we were able to lower his pain regiment to oxycontin 40mg po q8h and oxycodone 10mg po q6h:prn and topomax 25mg po daily. we discussed with the patient and his mother the fine balance needed between symptom control and maintaining his normal mental state and respiratory integrity. he will follow up with psych in the outpatient setting for eventual weaning off of the seroquel and diazepam. . #shortness of breath: likely multifactorial - obesity hypoventilation, pulmonary htn from osa, copd exacerbation, in the setting of taking multiple sedating medications. patient was originally admitted to the icu for respiratory failure requiring bipap in the ed. on arrival to the micu, he was on 2 l nc and while minimal shortness of breath and wheezing. he also also evidence of pulmonary edema on cxr but no sign of pna.continued prednisone 60 mg po daily and azithromycin 250 mg po daily . he was intubated for brief period of time and successfully extubated. continued home bipap at night and albuterol and ipratroprium nebs. home bipap settings are nasal cpap with psv, inspiratory pressure 18cm/h20, expiratory pressure 10 cm/h20, supplemental oxygen 2-6 l/min to maintain spo2 to >92%. he was diuresed 6.4l and was satting well at his goal o2 of 88-92% on ra at the time of transfer to the floor. he remained stable on the floor. . # chronic pain: he has severe, debilitating chronic pain bilateral hip avascular necrosis. his home narcotics and benzos were tapered and he was transferred to the floor with ciwa protocol. psychiatry consulted and recommended continuation of xanax during taper period with ativan for ciwa. pain service was also consulted and recommended new regimen of standing oxycontin 40mg po q8h with oxycodone 10mg q6h:prn as well as topomax 25mg daily. on this new regiment, we were able to achieve his baseline pain of . he was discharged on this new regiment. . # schizophrenia: pt denied ah/vh. psych was consulted and recommended starting risperidal alongside seroquel and slowly tapering seroquel, because of its sedative effects. he will also continue diazepam 1mg qid for now with plan to taper off of benzodiazepines in the future. . # diabetes: patient was continued on home insulin 70/30 regiment with a sliding scale that was higher than normal because he was on steroids during his stay for possible copd exacerbation. his sugars were high while on the steroids, but manageable with his iss. his metformin and glyburide were restarted at the time of discharge. . # hypertension: continued home metoprolol, lisinopril, and losartan, hctz, amlodipine with holding parameters =================================== transition of care: -patient's bipap settings are: nasal cpap w/psv (bipap) ----inspiratory pressure: 18 cm/h2o ----expiratory pressure: 10 cm/h2o ----supplemental oxygen: 2-6 l/min to maintain spo2 to >92 - patient needs follow up with psychiatry medications on admission: -buspirone 15 mg po bid -glipizide er 10 po twice a day. -metformin 850 mg po three times a day with meals. -lisinopril 40 mg po once a day. -metoprolol succinate 100 mg po daily - quetiapine 600 mg po qhs - oxycodone er 80 mg tid - oxycodone 10 mg po q3-4h - losartan-hydrochlorothiazide 100-12.5 mg po once a day - alprazolam 2 mg po qid prn (takes 4 mg qam and qpm) - albuterol sulfate 90 mcg 2 puffs q6h prn sob/ wheezing. - ipratropium bromide 17 mcg 2 puffs q6h prn sob/ wheezing. - risperidone 1 mg po qam and 2 mg tablet po hs (not taking) - multivitamin po once a day. (not taking) - insulin nph & regular human 100 unit/ml (70-30)- 40 units - vitamin d 50,000 units po once a week (not taking) - amlodipine 5 mg po daily - tamzepam 30 mg po qhs - atorvastatin 40 mg po daily discharge medications: 1. buspirone 15 mg tablet sig: as directed tablet po twice a day: please take one pill (15mg) in am, and two pills (30mg) in pm . disp:*90 tablet(s)* refills:*2* 2. glipizide 10 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po twice a day. 3. metformin 850 mg tablet sig: one (1) tablet po three times a day: with meals. 4. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 5. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 6. quetiapine 300 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po hs (at bedtime). 7. losartan-hydrochlorothiazide 100-25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 9. outpatient physical therapy patient has difficulty ambulating pain, would benefit from outpatient pt. 10. nicotine 21 mg/24 hr patch 24 hr sig: one (1) transdermal once a day. disp:*30 * refills:*2* 11. ipratropium bromide 0.02 % solution sig: two (2) puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 12. risperidone 1 mg tablet sig: three (3) tablet po hs (at bedtime). disp:*90 tablet(s)* refills:*2* 13. multivitamin tablet sig: one (1) tablet po daily (daily). 14. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 15. oxycodone 40 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q8h (every 8 hours). disp:*90 tablet extended release 12 hr(s)* refills:*0* 16. oxycodone 5 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 17. topiramate 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 18. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 20. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 21. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily). disp:*1 bottle* refills:*2* 22. insulin nph & regular human 100 unit/ml (70-30) suspension sig: forty (40) units subcutaneous twice a day. 23. alprazolam 1 mg tablet sig: one (1) tablet po four times a day. disp:*120 tablet(s)* refills:*0* 24. quetiapine 100 mg tablet sig: 1-2 tablets po at bedtime as needed for insomnia. disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: health systems discharge diagnosis: obesity hypoventilation syndrome narcotic/benzo overdose copd exacerbation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure participating in your care at . you came to the hospital because you were confused. your oxygen levels were found to be low so you were admitted to the icu. you are on many medications that can reduce your respiratory drive, or urge to breathe. notably, narcotics (oxycontin and oxycodone) and benzodiazepines (xanax) can do this, so these medications were reduced for your safety. you were also given medications to treat a possible copd exacerbation and reduce extra fluid in your lungs. please attend the follow-up appointment listed below with your primary care doctor to help determine a pain management regimen that does not cause as many respiratory side effects. you should also follow up with your psychiatrist to figure out how to best treat your anxiety. we made the following changes to your medications: 1. increased buspirone (buspar) to 15mg in the am, and 30mg in the pm 2. decreased quetiapine (seroquel) to 300mg before bedtime, plus an extra 100-200mg if needed for insomnia 3. decreased oxycontin to 40mg by mouth three times daily 4. decreased oxycodone to 10mg by mouth every 6 hours as needed for breakthrough pain 5. decreased alprazolam (xanax) to 1 mg by mouth four times daily 6. changed risperidone (risperdal) to 3mg by mouth at bedtime 7. increased losartan-hydrochlorothiazide to 100-25mg by mouth once daily 8. stopped temazepam (restoril) 9. started docusate (colace) 100mg by mouth twice daily 10. started senna 1 tab by mouth twice daily 11. started polyethylene glycol (miralax) 17 gram/dose powder by mouth daily followup instructions: please call your psychiatrist dr. () to schedule a follow-up appointment as soon as possible (within the next 1-2 days). please call medical care (1-): this company will help to optimize your home bipap settings and make sure they are correct. department: square, primary care doctor when: tuesday at 11:20 am with: , md building: (, ma) campus: off campus best parking: on street parking procedure: arterial catheterization diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) other chronic pain tobacco use disorder unspecified essential hypertension chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases other opiates and related narcotics causing adverse effects in therapeutic use unspecified schizophrenia, unspecified acute respiratory failure long-term (current) use of insulin osteoporosis, unspecified morbid obesity other constipation metabolic encephalopathy opioid abuse, continuous disorders of magnesium metabolism barrett's esophagus acute edema of lung, unspecified major depressive affective disorder, single episode, severe, specified as with psychotic behavior pain in limb obesity hypoventilation syndrome barbiturates causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to