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: bactrim / erythromycin / nsaids attending: chief complaint: drug overdose major surgical or invasive procedure: endotracheal intubation history of present illness: 44 y.o. woman with a history of prescription drug abuse, bipolar disorder, recently admitted for multiple drug overdose. per emergency department note, the patient apparently took a mixture of 0.1mg clonidine, suboxone, and gabapentin. pt was found in the homeless shelter with altered mental status and a prescription of suboxone. in the emergency department the patient was intubated for apnea. a toxicology consult recommended supportive care. pt received an amp of bicarb given ekg showed prolonged qrs. following amp of bicarb repeat ekg showed no change in qrs. of note pt was recently admitted to the ed after experiencing headaches and seizure. she was noted to have an elevated lactate as well as an anion gap which closed the following day. at that time she also talked to a resident requesting demerol for a headache, when told it was an inappropriate medication, she became unhappy and accused the medical team of not trusting her. she repeated this request to multiple providers. per her pcp, has received various narcotics from different prescribers around the city. she was also tested positive for methadone which she denied taking. in the ed, initial vital signs: t 98.8, hr 94, bp 109/75, rr 14, sat 100%. per ed note, the patient's rr was depressed at 10bpm, slurred speech was noted. in the pt was noted to have no leukocytosis, u/a was negative, lactate 1.4, +serum tca level. negative urine tox. pt was noted to be altered on presentation and was given narcan. given continued concern pt was intubated for airway protection for apnea. tox consult was obtained and recommended supportive care. pt had an ekg which showed a qrs of 108, he received an amp of bicarb and an ekg was repeated which showed no changed. cxr in the ed showed right mainstem intubation and the tube was pulled back. pt was originally on versed/fentanyl for sedation. past medical history: 1. recurrent bouts of bronchitis. 2. hypothyroidism. 3. bipolar disorder, well controlled on her current medications. 4. anxiety. 5. history of appendectomy. 6. status post ectopic pregnancy. 7. status post four back surgeries in , , and . per recent imaging, evidence of l5-s1 posterior fusion and anterior fusion with intravertebral discs 8. status post anoxic brain injury with damage to the basal ganglia status post mva . 9. migraine headache 10. status post repair of rectocele at the in 02/. 11. status post cystocele repair. 11. history of lower extremity dvt treated with 4 months of coumadin. social history: social hx: lives in shelter. originally from , was a hairdresser, but is currently unemployed and on disability (lives p/t with fiance). tobacco 1/2ppd x 20 or so yrs etoh: denies drugs: denies. family history: ms (distant relatives). seizure history. physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi 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 ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 09:30pm blood wbc-5.8 rbc-3.78* hgb-10.7* hct-30.9* mcv-82 mch-28.3 mchc-34.6 rdw-13.6 plt ct-286 09:30pm blood neuts-63.0 lymphs-28.3 monos-4.5 eos-3.6 baso-0.4 09:30pm blood pt-12.4 ptt-29.5 inr(pt)-1.0 09:30pm blood glucose-92 urean-12 creat-0.8 na-140 k-3.6 cl-105 hco3-27 angap-12 01:06am blood albumin-3.3* calcium-8.1* phos-2.9 mg-1.9 iron-37 01:06am blood ld(ldh)-142 01:06am blood caltibc-278 vitb12-262 folate-7.0 ferritn-13 trf-214 01:06am blood tsh-6.0* 09:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-pos brief hospital course: this is a 44 y.o. woman presenting with presumed drug overdose that required intubation initially for apnea. #. overdose: pt presented with overdose with + urine tox for tcas. suspected pt overdosed on 0.1 mg clonidine, suboxone, gabapentin. on admission pt was very lethargic with periods of apnea. given pt was not hypotensive and suboxone contains narcan, her overdose was initially suspected to be from gabapentin and amitriptyline causing cns depression. pt tested positive for tcas at a potentially toxic level. pt's qrs have remained borderline high and unchanged after amp of hco3. her ecg was monitored in the icu and remained stable without signs of a prolonging qrs. toxicology was consulted and recommended supportive care. psychiatry was also consulted who felt that this did not represent a suicide attempt, that the patient did not meet inpatient criteria and that the 1:1 sitter could be discontinued. social work was also consulted for addiction services. the patient was not interested in a detox program at this time. #. prescription drug abuse: patient repeatedly asked for a variety of drugs, including demerol, dilaudid, klonopin, suboxone and antibiotics. she has a documented history of drug seeking behavior, both on a previous admission ending and with one of her pcps here at the , dr. . dr. discovered by contacting her pharmacy that she had been filling narcotic prescriptions from multiple different providers. we contact her pcp at hospital, dr. (phone# , fax# ) in an attempt to centralize her prescribing. given her recent overdose, we did not feel comfortable discharging her with any prescriptions, referring her back to her clinic for suboxone management and dr. for prescriptions of her chronic medications. no changes were made to her medications. #. respiratory failure: was felt to be secondary to central respiratory depression from overdose. patient was intubated in the ed for apneic episodes and placed on propofol for sedation. the patient was weaned off propofol and extubated the day after admission. she initially desaturated when sleeping, but improved and was stable on the hospital floor without other worrisome respiratory symptoms. # fever: patient had temperature to 101.0 on . cxr and ua were negative. final blood and urine cultures were pending at the time of discharge. fever can be a side-effect of toxic levels of tcas. the patient reported that she had been given one dose of levofloxacin for presumed sinusitis prior to admission, but she did not have signs of bacterial sinusitis and no further antibiotics were given. # chronic back pain: patient has had four different surgeries for chronic low-back pain. she complained of continuously of pain in her back when asked despite having an unremarkable exam. she requested po morphine 15mg q4hrs as often as possible. no other narcotics were prescribed. #. hypothyroidism: she was continued on home regimen of levothyroxine. #. depression/bpd: no amitriptyline or quetiapine was given concern for possible overdose. she showed no signs of worsening depression or mania. she will follow-up with her outpatient providers. #. home situation: patient was not able to leave directly to the shelter as she may have been barred from returning there. she will stay temporarily with him before arranging to return to or going to another shelter. a taxi voucher was provided on discharge. *** a copy of this discharge summary will be faxed to dr. , patient's pcp, fax# *** medications on admission: albuterol inh amitriptyline 150mg po qhs clonazepam 2mg po tid gabapentin 800mg po qid levothyroxine 100mcg daily lidocaine patch (5%) omeprazole 40mg daily seroqual 50mg po bid discharge medications: 1. amitriptyline 150 mg tablet sig: one (1) tablet po at bedtime. 2. gabapentin 300 mg capsule sig: three (3) capsule po three times a day. 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. clonazepam 2 mg tablet sig: one (1) tablet po three times a day. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 6. diphenhydramine hcl 25 mg capsule sig: capsules po twice a day as needed. 7. quetiapine 50 mg tablet sig: one (1) tablet po twice a day. 8. clonidine 0.1 mg tablet sig: one (1) tablet po three times a day. 9. suboxone 8-2 mg tablet, sublingual sig: .5 tablet sublingual once a day. 10. nicotine 14 mg/24 hr patch 24 hr sig: one (1) transdermal once a day. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 12. suboxone 8-2 mg tablet, sublingual sig: one (1) tablet sublingual dinner. 13. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 14. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. discharge disposition: home discharge diagnosis: primary diagnoses: medication overdose respiratory failure secondary diagnoses: hypothyroidism bipolar disorder discharge condition: stable, breathing well on room air. discharge instructions: you were admitted with altered mental status and not breathing enough. you had to be intubated to help you breath. we think you had trouble breathing because you were taking too much of one or several of your medications. please only take your medications as prescribed. your breathing has improved and you are safe to home. no changes were made to your medications. you should get your suboxone from your clinic should you wish to continue taking this medication. you should get whatever other prescriptions you need from your pcp, . , at the hospital. please call your doctor, dr. if you have chest pain, difficulty breathing, fever and chills, hallucinations or seizures. followup instructions: you have an appointment with your primary care doctor hospital, dr. , wednesday at 1:30pm. his number is . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube drug detoxification diagnoses: unspecified acquired hypothyroidism anxiety state, unspecified acute respiratory failure lumbago bipolar disorder, unspecified accidental poisoning by anticonvulsant and anti-parkinsonism drugs other, mixed, or unspecified drug abuse, continuous poisoning by other and unspecified anticonvulsants poisoning by other antihypertensive agents poisoning by other specified analgesics and antipyretics accidental poisoning by other specified analgesics and antipyretics accidental poisoning by agents primarily affecting cardiovascular system accidental poisoning by antidepressants poisoning by tricyclic antidepressants 

Answer: The patient is high likely exposed to