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: no drug allergy information on file attending: chief complaint: aggitation, fever. major surgical or invasive procedure: lumbar puncture , endotracheal intubation and extubation. history of present illness: this is a 31 yo man h/o polysubstance abuse who was at for detox when he was noted to be aggitated and confused, then somnolent. he was transferred to for further evaluation. he was unresponsive per ems so given narcan x2. on arrival in the ed he was aggitated and appeared to be responding to internal stimuli. he was also tachycardic and febrile on arrival. he was given ativan and intubated with propofal in the ed. he additonally underwent lp. his ecg showed widened qrs and he was started on bicarbonate gtt for presumed tca toxicity (tox screen +). he had negative cxr and head ct. he was covered empirically with vancomycin and ceftriaxone in the ed but lp was negative for infection so these were stopped. he was transferred to the icu for further care. in the icu he was maintained on bicarbonate gtt for goal ph of 7.5 (7.51-7.53). his ecg improved by and the gtt was stopped . ecg remained improved. he was extubated without difficulty . he noted back pain at the sight of his lp, worse with movement. he feels not entirely himself, jittery, cloudy in his thinking. he does not recall being at for detox. he does not recall the events prior to transfer that led him to the ed. he does not recall taking a specific toxic ingestion and states he had no intetion to kill himself. he does acknowledge struggling with depressed mood in the past. ros: 10 point review of systems otherwise negative except as noted above. past medical history: -multiple admissions for substance detoxification since age 15 (heroin, cocaine, alcohol, benzodiazepines) social history: polysubstance substance with heroin, benzodiazepines, cocaine, and alcohol. he is currently unemployed and may be homeless, but states he lives with parents. he may or may not be married (denies it). he has a partner (wife, ex wife?) with whom he shares a 4 year old son. released from prison in . in the past he has worked as a car technician. family history: two sisters with a history of substance abuse and dependence. denies history of psychiatric illness in his family. physical exam: vs: t 97.2 hr 102 bp 153/87 rr 19 sat 100% ra gen: disheveled appearing man in nad eye: extra-occular movements intact, pupils equal round 8mm->5mm, reactive to light, sclera anicteric, not injected, no exudates ent: mucus membranes moist, no ulcerations or exudates neck: no thyromegally, jvd: flat cardiovascular: tachycardic but regular rhythm, normal s1, s2, no murmurs, rubs or gallops respiratory: clear to auscultation bilaterally, no wheezes, rales or rhonchi abd: soft, non tender, non distended, no heptosplenomegally, bowel sounds present, guaiac negative extremities: no cyanosis, clubbing, edema, joint swelling back: diffusely tender to palpation, especially at lp site and lower paraspinous musculature neurological: alert and oriented x3, cn ii-xii intact, normal attention, sensation normal, speech fluent integument: warm, moist, no rash or ulceration, multiple tattoos psychiatric: anxious, poor insight and judgement, unable to recall details of recent events hematologic: no cervical or supraclavicular lad pertinent results: labs: wbc: 7.3 hgb: 13.9 hct: 42.3 plt: 235 n:61.8 l:32.1 m:4.5 e:1.3 bas:0.3 145 109 14 agap=12 ------------- 104 3.4 27 0.8 ca: 8.6 mg: 2.2 p: 2.9 ck: 52 mb: notdone trop-t: <0.01 abg: 7.51, pco2: 39, po2: 262, hco3: 32 serum: tca positive serum: negative for asa, etoh, acetmnphn, benzo, barb serum valproic acid: 71 urine: positive for tca. negative for benzos, barbs, opiates, cocaine, amphet, methadone u/a negative lactate 1.3 micro: urine culture ng . blood cultures pending no growth to date x4. csf gram stain: no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): no growth. csf: 3 wbc, 35 rbc, 31 protein, 68 glucose. ekg: rhythm is probably sinus tachycardia with a-v conduction delay but rapid rate and unstable baseline make assessment difficult. intraventricular conduction delay. prominent qrs voltage. late precordial qrs transition. st-t wave abnormalities. ct head : no acute intracranial abnormality. if clinical warranted, mri may be a more sensitive study for hypoxia. chest xray (portable): no acute pulmonary process. brief hospital course: 31 yo man with polysubstance abuse with aggitation and altered mental status likely secondary to tca toxicity. 1. tca intoxication: unknown additonal co-ingestions but possibly narcotics, benzos, and likley anticholinergics, improved ecg with some residual tachycardia, s/p bicarbonate treatment. his ecg remains improved with no further events on telemetry, he is therefore deemed cleared for discharge from the medical service as of , with no further telemetry monitoring. he was monitored for benzo withdrawl as well given unknown co-ingestions with no evidence of withdrawl and low ciwa scores. his buspar, seroquel and remeron were all held. 2. tachycardia: suspect residual toxicity from anticholinergics, this improved as well. 3. suicide attempt: unclear intention but result was life threatening over-dose, does not appear to appreciate the gravity of his actions. he was seen by psychiatry who agreed with section 12, monitored on 1:1 sitter with suicide precautions. 4. depression: he was continued on fluoxetine and topomax, other possible home medications were held. 5. polysubstance abuse: this is a long-standing issue, multiple agents including cocaine, alcohol, benzos, narcotics, nicotine, heroin. sw was consulted to help with this. he was given thiamine, folic acid and multivitamin. 6. low back pain: this was thought related to his lumbar puncture or musculoskeletal pain, treated with tylenol, he refused nsaids, narcotics were avoided. a lumbar spine xray was done but revealed no abnormality. this was improved by discharge. 7. headache: he complained of severe headache on hospital day 4, per him responsive only to ativan or percocet. it was not positional in nature and there were no associated neurologic deficits so it was not thought to be a post-lp headache. he is a coffee drinker to cafeine withdrawl is possible. additionally there was concern for narcotic/benzo drug seeking. he was given tylenol, fioricet, and ibuprofen with intermittent relief. there was no other evidence to support benzo or etoh withdrawl as an etiology for the ha as there were no other signs or syptoms of this. medications on admission: home medication per , he also notes remeron and buspar but may be old: -mvi 1 tab po qam -thiamine 100mg po qam -folate 1mg po qam -seroquel 50mg qhs -prozac 20mg qam -bentyl 20g po bid -depakote 500mg (7 day course with last day on ) -clonidine prn 0.1g po bid -ibuprofen 400mg po q4h prn pain -mylanta 30cc po q6h gi upset medications on transfer: heparin 5000 unit sc tid multivitamins 1 tab po daily acetaminophen 325-650 mg po q6h:prn pain divalproex (delayed release) 500 mg po bid fluoxetine 20 mg po daily thiamine 100 mg po daily folic acid 1 mg po daily discharge medications: 1. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 2. divalproex 500 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid (2 times a day). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 7. quetiapine 50 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for aggitation. 8. ibuprofen 600 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain. 9. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: tablets po q6h (every 6 hours) as needed for headache. discharge disposition: extended care discharge diagnosis: primary: tca intoxication, suicide attempt, depression, polysubstance abuse. secondary: headache, nicotine dependence, low back pain. discharge condition: stable vital signs, continued complaints of headache, normal neurologic exam. discharge instructions: you were admitted with altered mental status after a toxic ingestion including tca's and other unknown substances. you initially had cardiac toxicity related to this but improved with treatment and your ecg returned to . you were monitored for benzo and etoh withdrawl but showed no signs of this. followup instructions: please follow up with your primary care doctor within 3 weeks of discharge. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube combined alcohol and drug detoxification diagnoses: tobacco use disorder other pulmonary insufficiency, not elsewhere classified depressive disorder, not elsewhere classified lumbago tachycardia, unspecified lack of housing other and unspecified alcohol dependence, continuous suicide and self-inflicted poisoning by other specified drugs and medicinal substances combinations of opioid type drug with any other drug dependence, continuous long qt syndrome myoclonus coma poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics elevated blood pressure reading without diagnosis of hypertension nystagmus, unspecified 

Answer: The patient is high likely exposed to