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: weakness, dizziness major surgical or invasive procedure: r subclavian central venous line placement history of present illness: 50 year old man with a h/o ptsd, mdd, and polysubstance abuse who was recently discharged from after a suicide attempt on , presented to the emergency room after having a syncopal event on the evening of discharge from the hospital. the patient reports that he was discharged home and throughout the day felt lightheaded and somewhat weak. the patient ate dinner, had a relatively uneventful evening, then went to the store with his son late in the evening. around 11pm, the patient was getting up out of his car when he reporting passing out in the parking lot near his home, got up once, then fell again and could not pick himself up off the floor. he states that his young 9 year old son was with him at the time, tried to help him but could not. neighbors who lived nearby called an ambulance to bring him to the nearest emergency room. the patient denies feeling excessively sad, and in fact states he feels much better since being discharged from the hospital yesterday. he adamantly denies that he was trying to hurt himself, or that he took any overdose of pills, or ingested any toxic substances. the patient is somewhat vague on the details of his story but denies any suicidal ideations at this time. he admitted to having vague mild abdominal discomfort, blurry vision associated with his lightheadedness, as well as two episodes of emesis while in the ambulance to the emergency department, but no fevers, chills, vertigo, chest pain, shortness of breath, diarrhea, constipation, dysuria, polyuria, or other complaints at this time. ed course: while in the ed, the patient was found to have a profound lactic acidosis as well as new acute renal failure and lft abnormalities. urine tox as well as serum tox screen was negative. tylenol level was undetectable and serum etoh level was 117. v/s in the ed: 96.5, 110/50, 98, 16, 98% ra; given his profound metabolic acidosis, the patient was admitted to the micu for further care past medical history: htn depression dm ii hyperlipidemia gerd chronic pain from prior work injury hand arthritis social history: pt with complicated social history. previously used to live with sister, whom them filed assault charges against the patient. since then has been estranged from his sister and has family discord. denies tobacco, etoh: has 2 "nips of brandy" on the night of , drinking occasionally/socially - pint of brandy + beers/occasion; does not see alcohol as an issue -denies withdrawal seizures/dts cocaine use 8-9 months ago by snorting; reported using it 1x/week; no use currently denies all other drugs; denies ivda family history: 2 sisters and 1 brother with depression. father and brothers with alcohol abuse. physical exam: vitals: t:36.3 bp: 101/59 p: 90 rr: 24 o2sat: 98% ra gen: resting comfortably in bed, not diaphretic or in any distress. heent: pupils approx 2mm, equal, round, reactive. conjunctiva pink. no scleral icterus. neck: supple, no lad, no nodules cv: tachycardic, regular, nl s1/s2, no murmurs, rubs, gallops, r sided tlc in place lungs: ctab, no w/r/r abd: soft, non-distended, non-tender. +bs ext: warm, well perfused, without le edema skin: no rashes or lesions noted neuro: aao x 3, cn ii-xii intact. tongue midline, no obvious facial droop, sensation grossly intact, 5/5 strength bilaterally. no finger to nose dysmetria, heel-to-shin maneuver normal. psych: poor eye contact. affect somewhat flat. no psychomotor retardation. pertinent results: complete blood count wbc rbc hgb hct mcv plt 12:55am 22.4*# 4.38*# 13.8*# 39.3*# 90 267# pt ptt inr(pt) 12:55am 14.0* 23.6 1.2* renal & glucose glucose urean creat na k cl hco3 12:55am 159* 38* 4.0*# 138 4.62 93*2 13*3 enzymes & bilirubin alt ast alkphos amylase totbili 12:55am 1437* 1137* 1058* 83 1.1 lipase 12:55am 198* cpk isoenzymes ck-mb mb indx 12:55am 44* 4.2 chemistry albumin calcium phos mg 12:55am 5.6* 11.5* 9.8*# 1.5* osmolality ethanol 12:55am 339* 115 lactate 04:51am 6.2* 04:02am 9.6* 02:47am 7.9* <br><b>studies:</b> cxr: unremarkable ruq u/s: limited study because of habitus. normal gall bladder. probable fatty liver. irregular, thickened tissue in the anterior abdomen of uncertain etiology, in the region of the stomach or duodenum, concerning for an infectious, neoplastic or inflammatory process. ct recommended. ct abdomen without contrast: enlarged, redundant stomach likely accounts for abnormality visualized on us. shrunken left kidney. evidence of prior splenic granulomatous infection. no free fluid or free air. . brief hospital course: 50 y/o m with h/o major depression, recent suicide attempt, dm on metformin, htn, dyslipidemia, and chronic pain, admitted w severe metabolic gap acidosis with concurrent new acute renal failure and liver enzyme abnormalities concerning for toxic ingestion/suicide attempt vs. metformin induced lactic acidosis. patient with profound metabolic acidosis on with lactate levels 7.9 --> 9.6 --> 6.2. osmolar gap ~ 16 with correction of alcohol level. other than toxic ingestion, other causes of profound lactic acidosis include metformin use in the setting of arf, inh toxicity, thiamine deficiency, and dehydration. ekg with qrs interval wnl. toxicology consult said to start empiric fomepizole treament for possible ethylene glycol ingestion. sent urine for oxalate crystals (to eval for ethylene glycol) & for evaluation under lamp for flourescence even though low suspicion. sent blood for ethylene glycol, methanol. tox screen came back positive for alcohol. started on empiric thiamine treatment 100mg iv daily x 3 days. ekg q8 hour x 24 hours. metformin d/ced. patient was hydrated and was able to take in po. anion gap closed with hydration. unclear if current picture related to major depression and if patient ingested toxic substances due to depression. psych consult does not believe so and said to d/c venlafaxine to make sure this is not contributing to organ disfunction. they also d/ced 1:1 sitter and suicide precautions as they spoke to outpatient psychiatrist and said they don't believe this to be the issue currently. acute renal failure this may be related to toxins or to poor po intake. picture unclear but renal believe it to be atn, hold ace inhibitor/metformin. renal following and does not think dialysis is needed. renally dose meds. for diabetes, cover w/regular insulin sliding scale and hold glipizide for now. new lft abnormality this with ast/alt >x5 uln. no history of hypotension on with sbp's stable in the 100's to 110's. unclear etiology. hold statin prescirbed for dyslipidemia. monitor lfts and synthetic function, including inr (currently 1.4). continue to monitor bp. for chronic pain, d/ced gabapentin q24 and no nsaids given bc of poor kidney function. for prophylaxis, continued on omprazole, given regular cardiac/diabetic diet, ambulation, ppi, pneumoboots. patient is full code. patient was then monitored on the floor for two days after transfer from the unit. he felt well except for some mild abdominal pain. it was likely related to his elevated lipase levels. by discharge his lab values had normalized and he was discharged home feeling well. he was off of ivfs and staying even with po intake and urine output. medications on : gabapentin 300 mg po tid simvastatin 40 mg po daily omeprazole 20 mg po daily metformin 500 mg po bid lisinopril 20 mg po daily aspirin 81 mg po daily glyburide 5 mg po daily venlafaxine 100 mg po bid discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lantus 100 unit/ml solution sig: twelve (12) units subcutaneous at bedtime. disp:*1 vial* refills:*0* 7. humalog 100 unit/ml solution sig: as per sliding scale subcutaneous qachs. disp:*1 vial* refills:*1* 8. insulin syringe microfine 0.3 ml 28 x syringe sig: one (1) miscellaneous qachs. disp:*100 syringes* refills:*1* 9. alcohol swabs pads, medicated sig: one (1) topical qachs. disp:*100 swabs* refills:*2* 10. one touch test strip sig: one (1) in qachs. disp:*100 strips* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: 1. syncope 2. anion-gap metabolic acidosis 3. acute renal failure secondary to atn . secondary diagnosis: 1. dm 2. depression 3. htn 4. gerd discharge condition: vital signs stable, afebrile, discharge instructions: you were admitted to the hospital after fainting. you were found to have some severe abnormalities in your electrolytes. we treated you with ivfs and monitored your heart and other organs very carefully. you were in the icu for about two days. . we continued to monitor your organs. we found that your kidneys and liver were injured. they continued to improve and we gave you iv fluids to help you as your body healed. . psychiatry also saw you and felt that your depression was well controlled. they stopped your antidepressant because it is metabolized by the liver and we did not want to add to your injury. dr. may start another antidepressent as an outpatient, once your liver function has totally improved. . we also treated your diabetes with insulin. we think the metformin may have been a cause of your metabolic problems. we are going to stop all your oral diabetes medicines and send you home on insulin. . please return to the hospital for any more fainting, dizziness, abdominal pain, chest pain, shortness of breath, or any other concerns. please call 911 if it is an emergency. if you feel increased depressive symptoms or thoughts of hurting yourself, come straight to the emergency room. followup instructions: you have an appointment with your psychiatrist on at 3:30 pm, in the with dr. . you have been given a slip to have your blood checked prior to that office visit. you also have an appointment with dr. on friday, at 11:50am. procedure: venous catheterization, not elsewhere classified diagnoses: acidosis esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified depressive disorder, not elsewhere classified 

Answer: The patient is high likely exposed to