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: history of the present illness: the patient is a 69-year-old woman with an extensive past medical history recently discharged on after a seven day stay for chf exacerbation and cellulitis. she was discharged to rehabilitation and then subsequently sent home. the patient was home for approximately one week. on the day of admission, ems was called by the home vna for finding the patient lethargic and hypoglycemic with fasting blood sugars approximately 41. the patient reports that she had been lethargic for approximately one week, very sleepy. ems found the patient lethargic and responsive to voice but inappropriate responsiveness. she was given 1 amp of d50 and fasting blood sugar of 145. the patient was given 2 mg of narcan and became more alert and oriented, although she was saturating into the 80s and had some eye fluttering that was thought to be possible seizure-like activity and emesis after given narcan which led to desaturation into the 80s and the patient was intubated for airway protection. in the ed, she was given thiamine 100 mg, ativan 2 mg times five, metomidate 20 mg, and succinylcholine 120 mg iv. past medical history: 1. coronary artery disease, status post multiple previous interventions. the most recent intervention was a ptca to the pda in . last catheterization was in when she developed pulmonary edema in the setting of a non st elevation mi and was referred to catheterization and found diffuse noncritical disease up to 60% in the rca and moderate pulmonary artery systolic hypertension. 2. diabetes mellitus, on insulin. 3. copd, on home oxygen, approximately 2 liters. pulmonary function testing of showed a restricted picture as well. 4. paroxysmal atrial fibrillation, managed with coumadin, originally managed with amiodarone and on norpace. the patient was dc cardioverted into normal sinus rhythm one month prior to this admission. 5. congestive heart failure secondary to diastolic dysfunction, ef of 75-80%, mild aortic regurgitation, and mild mitral regurgitation. 6. right anterior fracture in . 7. sleep apnea. 8. pulmonary embolism in . 9. chronic renal insufficiency. 10. status post thyroidectomy. 11. depression. 12. anemia with a negative colonoscopy and questionable small bowel av malformation. 13. osteoporosis. 14. peripheral vascular disease with venostasis ulcers and significant aortoiliac and tibial disease. 15. cellulitis history, positive mrsa colonization. 16. history of bronchiolitis obliterans organizing pneumonia in . 17. cholangitis in , status post ercp with sphincterotomy and laparoscopic cholecystectomy. allergies: the patient notes an allergy to penicillin, tegretol, beef or pork insulin, and zaroxolyn, although the patient takes humulin n and humulin r without any problems at home. outpatient medications: 1. aldactone 25 mg q.d. 2. anusol 25 mg q.d. 3. aspirin 81 mg q.d. 4. ativan 0.5 mg p.r.n. 5. lipitor 10 mg p.o. q.d. 6. buspar 15 mg p.o. three times daily. 7. calcitriol 0.25 micrograms q.d. 8. flexeril 60 mg p.o. q.d. 9. epogen 4,000 units q. week. 10. fentanyl patch 75 micrograms per last discharge summary. 11. folic acid 1 mg p.o. q.d. 12. fosamax 70 mg p.o. q. week. 13. lasix 80 mg q.d. 14. gabapentin 200 mg b.i.d. 15. humulin n as directed. 16. humulin r as directed, according to sliding scale. 17. levothyroxine 200 micrograms p.o. q.d. 18. nitroglycerin p.r.n. 19. os-cal 1,250 mg q.d. 20. prilosec 40 mg q.d. 21. toprol xl 150 mg p.o. q.d. 22. warfarin 1 mg p.o. q.d. 23. zestril 2.5 mg p.o. h.s. 24. zyprexa 2.5 mg p.o. q.d. 25. mirapex 0.5 mg p.o. q.d. 26. morphine sulfate 15 mg p.o. q. six to eight hours p.r.n. 27. wellbutrin 75 mg p.o. q.d. social history: the patient is a 69-year-old divorced woman, the mother of three grown children, and retired accountant. she lives alone in her own apartment in . her pcp is . . she hires people to help her with activities of daily living. the patient's daughter is her health care proxy. the patient is full code. she admits to rare alcohol use. she smoked marijuana occasionally. she has no other illicit substance use. she smoked cigarettes on and off for approximately 20 years but quit in . physical examination on admission: vital signs: 90.5 kilograms. she was afebrile. heart rate 68, blood pressure systolic 71, then 36, and then 90/44. ventilator settings were established. general: on examination, the patient was intubated and sedated with no apparent distress. heent: she had anicteric sclerae. the pupils were sluggishly reactive to light, symmetric and constricted to 2 mm bilaterally. she had a positive corneal reflex bilaterally. her et tube was in place 23 cm at her teeth. neck: supple with jvp to 9 cm at 30 degrees. cardiovascular: regular rate, normal s1, s2, question of a diastolic murmur at the right sternal border, no rubs or gallops audible. chest: occasional crackles bilaterally at the bases with rare rhonchi in the upper zones, moderate aeration. the patient was found to have two 75 microgram fentanyl patches on her back. abdomen: soft, nontender, nondistended, with positive bowel sounds, and no hepatosplenomegaly or pulsatile masses. extremities: warm, dry, with trace edema, and strong 2+ radial pulses bilaterally. she had 1+ pitting edema to her ankles with ace wraps on her lower extremities bilaterally for chronic venostasis ulcers present. neurologic: as stated, she was intubated and sedated with sluggish pupils but responsive. she moved all of her extremities periodically and had no overt seizure activity. skin: she had no diaphoresis. she had venostasis ulcers on her lower extremities and no rashes. laboratory/radiologic data: hematocrit 29.6, normal white blood cell count at 7.6, normal differential. electrolytes: bicarbonate 40, baseline in the low 30s, bun 40, baseline of approximately 32, creatinine 1.6 with a baseline of approximately 1.2 to 1.3. calcium, magnesium, phosphate, lfts, amylase, and lipase were all within normal limits. inr was 2.4. the u/a revealed specific gravity of 1.008, negative for leukocyte esterase or nitrates. head ct revealed no evidence of hemorrhage and a possible right occipital condyle fracture, but seemed to be old. chest x-ray showed cardiac enlargement, pulmonary edema of both lungs, and a right-sided pleural effusion consistent with fluid overload or chf with a superimposed infectious process could not be excluded by the radiologic findings. ekg revealed a sinus rhythm, normal axis, prolonged pr intervals, qtc greater than 430, and no st-t wave changes when compared with previous ekgs. assessment: the initial assessment was that she is a 69-year-old woman with an extensive past medical history who was admitted to the intensive care unit after being intubated in the setting of lethargy, a question of seizure activity, emesis, and recent hypoglycemia. the fact that the patient's mental status is most likely effected by medication, especially in the setting of her chronic renal insufficiency, there was also concern for pneumonia and given the patient's history of boop she was started on steroids. all psychoactive medications were withdrawn and the patient's mental status was monitored. it was concerning that the patient was wearing two 75 microgram fentanyl patches given her history of being only 75 micrograms at the last discharge. the patient reported that she was increased to 100 micrograms recently after requiring approximately 40-45 mg of p.o. morphine extra q.d. the patient reports that after that point her sleepiness began to overcome her each day and she found herself eating less each day but continuing to take all of her medications as prescribed including her insulin. on day number two of admission, the patient had a bronchoalveolar lavage to evaluate concern for boop. she was found to have an increased number of eosinophils but was not consistent with eosinophilia pneumonia and no organisms were found. it was not consistent with any allergic process. it seemed to be consistent with a chemical pneumonitis likely caused by the patient vomiting after receiving narcan. the patient's saturations improved. she was weaned off the ventilator on day number two. she awoke with a normal mental status requiring no further evaluation. after admission, on intubation, the patient went into atrial fibrillation/atrial flutter with frequent episodes of rapid ventricular rate into the 150s. she was managed with a diltiazem drip for some time and then was weaned off it and rate control was achieved with metoprolol around the clock. on day number two of admission, the patient also had a cosyntropin stimulation test to assess renal insufficiency given her hypotension that was seen in the emergency department upon presentation. the results of the test were not completely normal. it was unclear at this time whether this represented adrenal insufficiency or the effects of etomidate. the patient was maintained on steroids which were tapered off rapidly and no further hypotensive events occurred. hospital course: 1. delta ms: this was resolved on day number two of admission. the patient's pain medication and psychiatric medications were slowly administered to her without any loss of mentation. the patient revealed no evidence of infection despite being treated with multiple broad spectrum antibiotics which were then withdrawn within four days as no cultures revealed any focus of infection. 2. congestive heart failure: the patient was initially hypovolemic. she was aggressively diuresed upon being transferred to the floor on day number five of admission. she was continued on an increased dose of lasix p.o. and was diuresing 500 to 1 liter per day. at the time of discharge, the patient's oxygen saturations were 97% on 2 liters. she had no evidence of increased jvp, no lower extremity edema, and no extra heart sounds. she was clinically compensated for chf with diastolic dysfunction. 3. atrial fibrillation/atrial flutter: the patient had multiple episodes of rapid ventricular rate into the 150s as well as multiple episodes of bradycardia into the 20s. the patient mentated throughout all of these and did not have blood pressures decrease. ep was consulted. they instructed that norpace should be continued at 100 mg p.o. q. eight hours. it had previously been held in the unit secondary to concerns for it causing hypoglycemia as well as renal insufficiency and decreasing its own clearance. norpace was continued. the patient was continued on coumadin. the patient was monitored on telemetry. she did have one episode of a six second pause in which she was in atrial fibrillation with no ventricular response. she mentated throughout this episode and complained only of heartburn requiring maalox for full alleviation. electrophysiology was consulted with dr. as well as dr. . the patient was taken back to the sicu and dc cardioverted into normal sinus rhythm. coumadin and norpace were continued and the patient was instructed to follow-up with dr. in two weeks to consider av node ablation and pacemaker placement. 4. hypertension: the patient's blood pressure has remained in the normal range and were well controlled in the 110s to 120s when she was taking her antihypertensive medication. 5. chronic renal insufficiency: renal function was monitored. all medications were renally dosed. the patient's creatinine decreased to 1.1 which was below her previous baseline. 6. ? right lower extremity cellulitis: the patient had a venouse stasis ulcer there. dressings were continued. there was no evidence of erythema or warmth. the patient had no increase in white count and remained afebrile throughout the entire admission. it was felt that this was not infected. the wound was found to be mrsa positive with sparse growth but no antibiotics were administered or indicated. the patient will follow-up with her vascular surgeon regarding this. 9. depression: the patient had a history of depression, frequently became visibly upset throughout her hospitalization. she was maintained on her buspirone and celexa and felt that the only way that her depression could be managed would be if she was discharged to home so that she could plan with her family. 9. diabetes type 2: the patient was maintained on nph as well as sliding scale humulin insulin. she was maintained on a diabetic diet. she ate well throughout admission and had no further hypoglycemic events. 10. chronic pain: the patient has chronic lower extremity neuropathic pain requiring aggressive medical management. the patient was maintained on a 25 microgram fentanyl patch as well as p.o. dilaudid at 2-4 mg q. six hours p.r.n. gabapentin 600 mg t.i.d. was given. she was also maintained on 500 mg of tylenol around the clock. the patient was also instructed to discuss with her pcp other analgesic regimens as well as nonpharmacologic pain therapy to improve her functional status. 11. hypothyroidism: the patient was considered to be stable. she was continued on her levoxyl. 12. question of acth deficiency: the patient was rapidly tapered off of steroids. at the time of discharge, the patient was instructed to take 20 mg p.o. for one day and then 10 mg p.o. the next day and then be off the steroids entirely. on the date of discharge, the patient was ambulating well, was cleared by physical therapy, was above previous baseline and function. she was saturating in the high 90s on 2 liters nasal cannula oxygen, breathing well with minimal pain and her heart was in normal sinus rhythm. she was eating and drinking well and ready to go home. she was sent home with continued vna services as well as her home care assistant. she was instructed to follow-up in one week with dr. . she was instructed to follow-up in the second week of with dr. for consideration of av nodal ablation and pacemaker placement. the patient was also instructed to see her podiatrist regularly. discharge diagnosis: 1. arrhythmia, atrial fibrillation/atrial flutter. 2. congestive heart failure, right-sided heart failure, left heart failure. 3. diastolic dysfunction. 4. diabetes type 2 with nephropathy. 5. depression. 6. anemia. 7. hypertension. 8. pneumonia. 9. medication overdose, adverse effect. 10. hypoglycemia. 11. foot ulcers. 12. peripheral vascular disease. 13. diabetes mellitus. 14. chronic neuropathic pain. 15. chronic obstructive pulmonary disease requiring oxygen. 16. status post intubation for respiratory failure. 17. acute renal failure. 18. chronic renal insufficiency. 19. hypothyroidism. 20. osteoporosis, methicillin-resistant staphylococcus aureus positive. the patient received the influenzae vaccine during her admission. discharge medications: 1. albuterol 90 micrograms one to two puffs p.r.n. 2. atrovent 18 micrograms one to two puffs q. six hours p.r.n. 3. multivitamin q.d. 4. folic acid 1 mg q.d. 5. buspirone 5 mg b.i.d. 6. epogen 4,000 units q. week. 7. lisinopril 5 mg p.o. q.d. 8. fentanyl 25 micrograms per hour patch q. 72 hours. 9. spironolactone 75 mg p.o. q.d. 10. protonix 40 mg p.o. q.d. 11. maalox p.r.n. 12. lipitor 10 mg p.o. q.d. 13. celexa 60 mg p.o. q.d. 14. aspirin 81 mg p.o. q.d. 15. levoxyl 200 micrograms p.o. q.d. 16. bisacodyl p.r.n. 17. metoprolol 100 mg p.o. b.i.d. 18. warfarin 4 mg h.s. with inr to be followed by primary care physician. 19. disopyramide phosphate/norpace 100 mg p.o. q. eight. 20. saline nasal spray q.i.d. 21. tylenol 500 mg p.o. q. six hours around the clock. 22. humulin n 20 units q.a.m., 5 units q.h.s., humulin 100 unit per mil cartridge sliding scale as directed. 23. lasix 40 mg p.o. b.i.d. 24. prednisone 20 mg p.o. q.d. to be taken for one day, 10 mg to be taken the subsequent day, and then no prednisone. 25. gabapentin 600 mg t.i.d. 26. miconazole powder p.r.n. 27. hydromorphone 2 mg p.o. q. six hours. 28. calcium and vitamin d two tablets p.o. q.d. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization atrial cardioversion closed [endoscopic] biopsy of bronchus diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation other convulsions acute respiratory failure pneumonitis due to inhalation of food or vomitus poisoning by other opiates and related narcotics ulcer of heel and midfoot 

Answer: The patient is high likely exposed to