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 / penicillins attending: chief complaint: acetominophen toxicity major surgical or invasive procedure: picc line placement history of present illness: this is a 40 yo female with long h/o depression initially admitted to micu from osh for eval for liver transplant for likely acute tylenol toxicity possibly suicide attempt and now transferred to the liver service with improving liver enzymes and mental status. patient was admitted to hospital on for worsening depressive symptoms, auditory hallucinations, and altered mental status. she was found to have an initial transaminitis of ast 1700 and alt 1614 with t.bili 3.3 (direct 2.7). during her 24 hrs at , she progressively worsened such that prior to transfer, her ast was 5495, and alt 5039 with t.bili of 3.4. her inr was 2.4 prior to transfer. her creatinine was also elevated initailly at 2.1 but improved to 1.5 prior to transfer. at the osh, her ct abdomen showed moderate fatty infiltration of the liver, and abdominal us showed s/p cholecystectomy, but no biliary dilation. there was no comment on portal vein thrombosis. a ct head was also negative. prior to transfer to , the patient had been intubated due to worsening mental status. there is no other documentation regarding that event. her vitals were stable prior to transfer. she was transferred on a propofol gtt. she had also received a nac infusion while at for concern of acute acetaminophen induced hepatic injury, though her acetaminophen level was low at the osh. she may have ingested large quantities of tylenol ? days prior to presentation - per notes, her mother states that she had emailed her ex-husband stating she planned to od on tylenol and left a suicide note. patient arrived at on and was extubated within 24 hours of arrival to micu. patient found by transplant team not to need liver transplant as labs have improved. patient was continued on nac (inr on transfer is 1.8) and has been receiving increasing lactulose (without bowel movements) for encephalopathy. she also has acute renal failure, likely atn from tylenol, and has been followed by the renal team. patient with ngt - she has had sips but otherwise not eating. mental status is currently somnolent. on arrival to the floor, she is sleeping and appears comfortable. she is not able to answer any questions. all history was obtained from the medical records from the osh and the patient's husband and daughter. past medical history: 1) depression 2) s/p appendectomy 3) s/p cholecytstectomy 4) s/p d&c 5) acute bronchitis -> pna in 6) chronic r-sided chest pain with ? findings on imaging (per husband - images were done as part of pna work-up) social history: patient lives with her husband of ~2 years. she is unemployed. she smokes ppd and denied alcohol or drug use. has two sisters and , brother . (father , mother () are also involved in her life. daughter from her previous marriage lives in . family history: - father with etoh cirrhosis - both living physical exam: vitals - t: 97.4 bp: 127/73 hr: 101 rr: 22 02 sat: 99% on ra general: sleeping in bed. opens eyes very briefly in response to name, non-verbal at this time. follows some commands, although very weak/somnolent. nad. heent: ngt in place. conjunctival hemorrhages (obtained during transfer from osh) obscure sclera bilaterally; skin does not appear overtly jaundiced. cardiac: tachycardic but regular, no murmur/rub/gallop lung: cta bilaterally although exam compromised by somnolence (cannot breathe deeply, difficult to position) abdomen: soft, ? ttp worst over ruq and epigastric regions, + nabs ext: 2+ dp pulses bilaterally. trace non-pitting pedal edema. neuro: cannot assess sensation, strength at this time. derm: some ecchymoses around eyelids (per husband, related to taping her eyelids shut during transport from osh) pertinent results: labs on admission: 10:16pm fibrinoge-202 10:16pm pt-37.3* ptt-35.6* inr(pt)-3.9* 10:16pm plt count-98* 10:16pm neuts-93.5* bands-0 lymphs-4.6* monos-1.1* eos-0.3 basos-0.5 10:16pm wbc-12.5* rbc-4.28 hgb-12.9 hct-37.9 mcv-89 mch-30.2 mchc-34.1 rdw-13.9 10:16pm hcv ab-negative 10:16pm acetmnphn-neg 10:16pm hbsag-negative hbs ab-negative hav ab-negative igm hbc-negative igm hav-negative 10:16pm osmolal-292 10:16pm albumin-3.4 calcium-7.1* phosphate-2.8 magnesium-2.7* 10:16pm alt(sgpt)-7683* ast(sgot)-8243* ld(ldh)-8510* alk phos-122* tot bili-4.0* 10:16pm estgfr-using this 10:16pm glucose-155* urea n-30* creat-1.6* sodium-131* potassium-4.2 chloride-100 total co2-13* anion gap-22* 10:21pm d-dimer-greater th 11:14pm lactate-4.9* 11:14pm type-art po2-360* pco2-26* ph-7.38 total co2-16* base xs--7 11:17pm fdp-80-160* labs on discharge: : wbc-9.4 hb-10.3 hct-30.9 plt-228 : na-137 k-4.0 cl-103 hco3-25 bun-17 cr-0.7 glu-100 : ca-9.1 mg-1.8 phos-3.5 : alt-113 ast-80 tuberculosis-2.6 ap-139 alb-3.6 ldh-177 : ptt-30.1 inr-1.0 ================ imaging: ======== echocardiogram : the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild pulmonary artery systolic hypertension. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. ======== portable cxr : impression: ap chest reviewed in the absence of prior chest radiographs: very low lung volumes exaggerate heart size which is probably normal, and produce or reflect atelectatic crowding at the lung bases. the upper lungs are grossly clear. there is no pleural effusion or evidence of central adenopathy. tip of the endotracheal tube is at the level of the lower margin of the clavicles, no less than 15mm from the carina, probably 2 cm below optimal placement. ======== abdominal us with doppler : comparison: none. abdominal ultrasound: the liver is diffusely echogenic. there are no focal hepatic lesions. the right and left kidneys measure 10.7 cm and 11.9 cm in length, respectively. there is no hydronephrosis. a right parapelvic cyst measures 2.4cm x 2.3cm x 1.8cm. the head of the pancreas is unremarkable. the body and tail are not well seen due to bowel gas. there is no intrahepatic ductal dilation. the patient is status post cholecystectomy. the common duct measures 9 mm, normal in the setting of cholecystectomy. the spleen is normal in size. the aorta is not well seen due to bowel gas. doppler examination: the main, right and left portal veins are patent, with appropriate waveforms and anterograde, hepatopetal flow. the common hepatic artery is patent, with appropriate waveforms. the right, middle and left hepatic veins are patent, with appropriate waveforms as well as the superior mesenteric vein and inferior vena cava. impression: 1. echogenic liver consistent with fatty infiltration. other forms of liver disease and more advanced liver disease including significant hepatic fibrosis/cirrhosis cannot be excluded on this study. 2. right parapelvic renal cyst. 3. normal liver doppler examination. ======== ecg : sinus tachycardia, rate 103. low r wave voltage in leads v4-v6. poor r wave progression. mild non-specific st-t wave changes in ii, iii, avf and v4-v6. these changes are non-specific and non-diagnostic. no previous tracing available for comparison. brief hospital course: the following issues were addressed at this admission: 1. acute hepatotoxicity. believed secondary to acetominophen overdose. level at outside hospital was > 6, but patient likely did not present for 1-3 days post-ingestion (patient states she is unable to remember the exact circumstances surrounding overdose, and husband reports that she seemed very tired/ill about 2 days prior to admission). she was initially transferred to the micu for possible emergent transplantation. she was evaluated by the transplant team here. however, with nac and supportive therapy, lfts began to trend down and her mental status slowly improved. at the time of transfer to the floor on hospital day 3, she was still somnolent and not responding verbally to questions. she continued to receive nac until inr dropped below 1.5. lfts, bilirubin, inr have trended down steadily. inr has now normalized, while lfts, bilirubin are approaching normal. she is expected to recover normal liver function. 2. acute renal failure. believed secondary to atn (muddy brown casts, fena of 0.3) which is a known complication of acetominophen toxicity. creatinine peaked at 3.3 and then trended down slowly to (presumed) baseline of 0.7-0.8 by the time of discharge. 3. electrolyte wasting. the patient was noted to become hypokalemic and hypophosphatemic several days into this admission, requiring maximum supplementation of 180 meq of potassium and packets of neutra-phos daily. the potassium wasting was suspected to be secondary to a renal tubular defect (though patient was not acidotic at that time), given levels in the urine > 50 meq/l when serum values would indicate that < 5 meq/l would be expected. she was started on amiloride at 2.5 mg daily and increased to 5 mg daily, which reduced the urinary potassium wasting and helped to stabilize serum k values at ~4. she will be continued on this medication at discharge with a plan to follow up with the nephrology team for further outpatient management. the low phosphate may have been partially secondary to wasting in the urine but is also common in hepatic regeneration given increased physiologic demand. her phos level stabilized without the need for supplementation prior to discharge (though patient has been encouraged to drink 1 cup of skim milk with meals to help supplement). finally, magnesium levels were noted to drop several days after the k wasting began. she continued to require grams of supplementation daily until , when levels remained in the normal range without supplementation. amiloride was stopped on and potassium levels remained stable in the normal range. she will require follow up of her electrolytes at her outpatient renal follow up appointment. 4. depression. after regaining full consciousness, the patient acknowledged that she has been struggling with depression for some time. she states that she is "terrified" that she tried to hurt herself in this way. after much negotiation, the patient's husband brought in a note that she had written, stating that voices were telling her that it was time to die. in addition, her mother reported that she had sent an email to her ex-husband threatening acetominophen overdose several days prior to admission; her current husband denied knowledge of this event. she was followed by psychiatry and social work throughout this admission, and maintained off all psych meds (including home xanax and seroquel). she is future-oriented and expresses interest in inpatient psychiatric therapy. she has generally received good social support from her family (sisters, daughter, husband, ) throughout this stay, and states that much healing has taken place between her family members. of note, during her time on the floor, she was placed under 1:1 observation by a sitter for her own safety. several mornings prior to discharge, the patient told the team that she had been verbally abused by three consecutive night sitters (stating that they had made comments such as "if i were your daughter, i would never forgive you" and "if i were your husband, i would never let you leave the house again." this incident was reported to the sitter coordinator and is under investigation. however, there is suspicion that the patient either fabricated these accusations or perhaps hallucinated (she had reported hallucinations at the time of admission to the osh, and could possibly have depression with psychotic features or other psychiatric disorder), as these were three independent staff members and this is unexpected behavior from staff, who are generally well-trained. these issues require further investigation by her future psychiatry team. on the day of her discharge, her psychiatry team determined that she was no longer actively suicidal and cancelled her section 12 and requirement for 1:1 sitter. at the patient's request, she was discharged later that same evening with the understanding that she will be referred to an outpatient program or personal psychiatrist. medications on admission: 1) seroquel 300 mg qhs 2) xanax 1 mg q8h prn 3) valerian root for insomnia (per husband) 4) melatonin for insomnia (per husband) discharge medications: 1. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia: please attempt to wean off of this medication within 2 weeks. disp:*7 tablet(s)* refills:*0* 2. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (fr) for 4 weeks. disp:*4 capsule(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: - acute hepatotoxicity secondary to acetominophen overdose - acute tubular necrosis secondary to acetominophen overdose - renal tubular defect (exact pathophysiology uncertain; no acidosis) resulting in electrolyte wasting presumed secondary to acetominophen overdose - depression - hypokalemia - hypomagnesemia - hypophosphatemia secondary: - anxiety discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were transferred to with liver toxicity related to acetominophen (tylenol) overdose. you were initially admitted to the icu and evaluated by the transplant team for possible liver transplantation. however, with appropriate supportive care, your liver function recovered. you were also noted to have kidney failure upon arrival to . you were evaluated by the renal team, who felt that your kidney failure was related to the acetominophen overdose. you were noted to pass large amounts of electrolytes in your urine, which was felt also to be related to the kidney injury by the acetominophen. your electrolytes were closely monitored and you received appropriate supplementation. because of concern that your overdose was intentional, you were followed closely by the psychiatry team during your stay. they initially recommended transfer to an inpatient psychiatric facility where you would therapy to address issues of underlying depression and mental health problems. today the psychiatry team met with you and felt as you were not longer endorseing suicidal thoughts, it would be safe to be discharged home with a half day program to be arranged tomorrow. you will be contact by the psychiatric case manager tomorrow to arrange this. please call and ask for dr. or dr. if you do not hear from someone tomorrow. we have made the following changes to your medication regimen: - stop taking xanax (you will be treated for anxiety according to recommendations from your inpatient pscyhiatry team) - stop taking seroquel (you will be treated for depression according to recommendations from your inpatient pscyhiatry team) - take as needed ambien (zolpidem) for insomnia. you should try to wean yourself off of this medication within two weeks, as it may become habit-forming and is not intended for long-term use. please keep your follow up appointments as outlined below. followup instructions: you have a follow up appointment scheduled with your primary care physician . on at 1:30pm. please call if you need to reschedule: (. liver: you have a follow up appointment scheduled with dr. at 3:20pm on at the liver center. please call if you have questions or need to reschedule. renal: you will need to follow up with the kidney doctors who treated while in the hospital. someone from their department will be contacting you to arrange an appointment with dr. or one of her colleagues. their office number is ( procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine diagnoses: acute kidney failure with lesion of tubular necrosis hypopotassemia dysthymic disorder acute respiratory failure disorders of phosphorus metabolism other acquired absence of organ other constipation other encephalopathy poisoning by aromatic analgesics, not elsewhere classified suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics other and unspecified coagulation defects gastroesophageal laceration-hemorrhage syndrome disorders of magnesium metabolism hepatitis, unspecified mixed acid-base balance disorder other specified gastritis, with hemorrhage 

Answer: The patient is high likely exposed to