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 known allergies / adverse drug reactions attending: chief complaint: aspirin and tylenol ingestion major surgical or invasive procedure: femoral dialysis line placement picc line placement history of present illness: 60 year old female with pmh of depression followed by a psychiatrist with h/o suicide attempt 15 years ago and past psychiatric hospitalizations (last 1 year ago), bipolar disorder, htn, and hypothyroidism who initially presented to at 4:30pm on s/p an overdose of reportedly 300 tablets of aspirin and 10 tablets of tylenol extra strength at 3:30pm this afternoon. she said that this was a suicide attempt but reported no other co-ingestions. she denied cp/sob, abdominal pain, and diarrhea at . she vomited twice at , both times were non-bloody. initially when she presented to : 4:21 pm - etoh neg, tylenol 87, aspirin 9.7 6:45 pm - lfts neg, tylenol 40.3, aspirin 63.2 bicarb=24.5 cr 1, k 4.6 ekg: qrs 102 she was started on a bicarb drip at , given activated charcoal, and transferred to for toxicology. . in the ed, initial vs were: 97.8, 88, 130/80, 18, 96% ra. an ekg showed sinus rhythm at 90, na/ni, twi in iii. cxr shows bilateral increased vascular markings but no acute infiltrate. initial tox screen showed asa=42 and tylenol=44. toxicology was consulted and recommended q2 hour aspirin levels and alkalinization of the urine with a goal ph of 7.5-8.0. she was started on bicarb drip at 150cc/hr titrated to 1-2cc/kg/hour urine output. toxicology recommended no intubation. if asa levels increase or acidosis is refractory, toxicology wanted renal consultation for dialysis. no indication for nac. bicarb was to be stopped when aspirin level is 30 or less. patient received another dose of activated charcoal. transfer vitals: 148/83, 98, 16, 97% ra . on arrival to the micu, patient was uncomfortable and obtunded on admission, but still redirectable. around 5am she became completely obtunded and generally unreponsive in correlation with her asa level rising to above 90. past medical history: -hypothyroidism -depression -bipolar disorder -hypertension social history: she is not working. she drinks alcohol socially. she does not smoke. she is married. her activity level is quite low at baseline because of pain. family history: non-contributory physical exam: on admission: vitals: t: 98.3, bp: 132/64, p: 110, r: 23 o2: 96% general: obtunded, tachypneic, uncomfortable appearing, diffusely erythematous heent: sclera anicteric, dry mm neck: supple cv: tachycardic lungs: tachypneic, clear to auscultation bilaterally with some rales bilaterally at bases abdomen: soft, non-tender, non-distended, bowel sounds present gu: foley ext: warm, no clubbing or edema neuro: obtunded . at discharge: 98.9, 139/94, 75, 18, 94% ra general: aaox3, anxious but well appearing female in nad heent: sclera anicteric, mmm, eomi, perrla neck: supple, no jvd, no lymphadenopathy cv: rrr, no m/r/g lungs: ctabl, reduced air entry bibasally. abdomen: soft, non-tender, non-distended, bowel sounds present ext: warm, no clubbing or edema neuro: cnii-xii grossly intact. moving all four extremities. pertinent results: admission labs: 10:45pm wbc-7.7 rbc-3.64* hgb-11.6* hct-33.5* mcv-92 mch-31.8 mchc-34.5 rdw-13.2 10:45pm neuts-72.4* lymphs-19.5 monos-4.1 eos-3.7 basos-0.4 10:45pm plt count-378 10:45pm urine color-straw appear-clear sp -1.004 10:45pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-tr 10:45pm urine rbc-2 wbc-3 bacteria-none yeast-none epi-0 10:45pm asa-42.0* ethanol-neg acetmnphn-44* bnzodzpn-neg barbitrt-neg tricyclic-neg 10:45pm alt(sgpt)-11 ast(sgot)-46* ld(ldh)-759* alk phos-85 tot bili-0.2 10:45pm glucose-89 urea n-23* creat-1.2* sodium-142 potassium-8.0* chloride-108 total co2-23 anion gap-19 10:56pm type- po2-52* pco2-37 ph-7.48* total co2-28 base xs-3 . discharge labs: 10:22am blood wbc-8.2 rbc-3.42* hgb-10.7* hct-32.9* mcv-96 mch-31.2 mchc-32.3 rdw-13.8 plt ct-221 10:22am blood glucose-128* urean-11 creat-1.2* na-144 k-4.2 cl-113* hco3-22 angap-13 06:22am blood alt-71* ast-68* ld(ldh)-420* alkphos-76 totbili-0.3 10:22am blood calcium-8.3* phos-3.1 mg-1.9 . salicylate levels: 03:52am blood asa-93.8* acetmnp-26 07:06am blood asa-128* 09:14am blood asa-136.5* 11:23am blood asa-92.0* 02:41pm blood asa-27.8* 05:30pm blood asa-31.1* 11:37pm blood asa-32.1* 04:59am blood asa-31.0* 09:43am blood asa-31.6* acetmnp-neg 05:55pm blood asa-34.0* 08:58pm blood asa-30.5* 11:43pm blood asa-28.4* 04:01am blood asa-25.0 02:47pm blood asa-15.1 04:37am blood asa-6.8 05:08am blood asa-neg 06:22am blood asa-neg . abg/vbgs: 10:56pm blood type- po2-52* pco2-37 ph-7.48* caltco2-28 b03/07/12 11:52am blood type-art po2-109* pco2-14* ph-7.71* caltco2-18* 02:04pm blood type-art o2 flow-2 po2-110* pco2-21* ph-7.67* 05:09am blood type-art temp-37.3 po2-109* pco2-37 ph-7.51* 09:22pm blood type- po2-201* pco2-34* ph-7.51* caltco2-28 03:12pm blood type- po2-34* pco2-43 ph-7.47* caltco2-32* ecg: sinus rhythm. baseline artifact. low amplitude p wave. no previous tracing available for comparison imaging: ap cxr on admission: impression: no radiographic evidence for pulmonary edema. cxr the heart size is top normal. the hilar and mediastinal contours are within normal limits and unchanged. the aorta is slightly tortuous. the lung volumes are low, resulting in bibasilar atelectasis. however, there is a superimposed right basilar opacity which could represent aspiration or early pneumonia. linear left basilar opacities reflect atelectasis versus focal scarring, unchanged since the examination, but new neighboring opacities are also concerning for mild aspiration/consolidation. there is no pneumothorax. blunting of the left costophrenic angle is suggestive of a tiny pleural effusion. impression: 1. right basilar aspiration or consolidation. 2. possible left basilar consolidation or aspiration. 3. bibasilar atelectasis in the setting of low lung volumes. 4. tiny left pleural effusion. ruq u/s: impression: 1. prominence of the portal triads, correlate with lfts or right heart failure. 2. evidence of lithium nephropathy with bilateral innumerable tiny cysts. echogenic kidneys could also relate to medical renal disease. brief hospital course: 60 year old female with pmh of depression followed by a psychiatrist with h/o suicide attempt 15 years ago and past psychiatric hospitalizations (last 1 year ago), bipolar disorder, htn, and hypothyroidism who initially presented to at 4:30pm on s/p an overdose of reportedly 300 tablets of aspirin and 10 tablets of tylenol extra strength at 3:30pm this afternoon. #. toxic ingestion: the patient reported taking 10 tablets of extra strength tylenol and 300 tablets of aspirin. it was thought that she likely had an aspirin bezoar in her stomach that was slowly leeching out variable doses of aspirin. she received 2 doses of activated charcoal and was started on a bicarb drip with a goal ph 7.5 to 7.6. asa levels have trended from 9.7->63.2->42->93.8->128. this increase was associated with decreased consciousness but did not have any evidence of seizure. she was initially treated with n-acetylcysteine for the tylenol ingestion, but her serum levels trended down and nac was stopped as she was below the nomogram. she was extremely tachypneic during the first few days in the micu. her aspirin levels and abg were trended every 2 hours. as her pco2 remained low with the cns mediated tachypnea and she did not require intubation at any point. the morning of a femoral dialysis line was placed. she required three pressors (phenylephrine, neosynephrine, and vasopressin) to get her blood pressures high enough for dialysis. with 6 hours of dialysis, her aspirin level went from a peak level of 128 to 30. her mental status and tachypnea improved. her aspirin remained at 30 for 24 hours, raising the possibility of a continued bezoar. she was given 3 more doses of activated charcoal. her aspirin levels continued to trended down, and she did not require further dialysis, or egd to look for bezoar. her mental status slowly improved and respiratory rate trended back to normal. #. suicide attempt: patient has long history of bipolar disease and past suicide attempts. she apparently was decompensating prior to this ingestion. after her mental status improved, she was kept with a 1:1 sitter. she denied further plans to harm herself. her home lithium, citalopram, glycopyrrolate, clonoazepam were held. psychiatry was consulted. she will require inpatient treatment on discharge. . #. aspiration pneumonia: patient had one fever, suspected aspiration while getting activated charcoal. she was also hypotensive and difficult to wean off pressors, perhaps in part due to sepsis. she was started on antibiotics, and due to rapid clinical improvement, transitioned to po levofloxacin. she will need to complete a 14 day course of levofloxacin by . #. hypernatremia: she was hypernatremic on presentation, but blood sodium levels dropped to low 130s on the bicarbonate drip. following discontinuation of the bicarb drip, her sodium came up to 148. the patient had large urine output, dilute urine with urine osmolality 133 with serum osmolality 304. review of outpatient labs at revealed that hyponatremia has been chronic since at least 07/. the picture is consistent with nephrogenic diabetes insipidus as a consequence of chronic lithium use. her abdominal ultrasound also showed microcystic changes in the kidneys, consistent with lithium toxicity. her lithium levels were in the therapeutic range, and lithium was stopped during this hospitalization as above. per nephrology, the patient was given access to free water and encouraged to drink water. her hypernatremia remained stable. she will require outpatient followup with nephrology following discharge from inpatient psychiatry, and should be continued to be encouraged to drink plenty of water. #. hypotension: she had been persistently hypotensive after her toxic ingestion of asa, likely due to vasodilation from direct aspirin toxicity, possibly complicated by an aspirin bezoar or sepsis from aspiration pneumonia. she was maintained on three pressors to facilitate dialysis as above, but was successfully weaned off pressors on . following transfer to the floor, her blood pressure stabilised and trended up to sbp in the 150s. we restarted her home lisinopril and her blood pressures were stable and well-controlled at the time of discharge. # elevated lfts: likely secondary to tylenol toxicity combined with aspirin toxicity. lfts were trending down at the time of discharge, but she will require followup to ensure that lfts have normalized. #. hypothyroidism. continued home levothyroxine 88mcg daily. transitional issues: 1. she will require inpatient psychiatric treatment following discharge from the medical floor. psychoactive medications were held during this hospitalisation and may need to be reinstated as appropriate. 2. she was noted to have acute renal failure in the setting of toxic ingestions, but also chronic kidney disease of unclear etiology, likely secondary to lithium toxicity with nephrogenic diabetes insipidus. she will need to followup with nephrology as an outpatient. 3. please encourage drinking of water and ensure constant access to free water, to allow the patient to self-correct hyprnatremia secondary to nephrogenic diabetes insipidus. 4. please repeat lfts at follow up with primary care. 5. she will complete a course of levofloxacin for pneumonia on medications on admission: -levothyroxine 88mcg daily -lithium 300mg -citalopram 20mg daily -dulcolax daily -mvi daily -glycopyrrolate 1mg tid -clonazepam 0.5mg daily -lisinopril 2.5mg daily discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 2. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 3. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily) for 9 days: last day . 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 6. dulcolax 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day as needed for constipation. 7. multivitamin tablet sig: one (1) tablet po once a day. discharge disposition: extended care discharge diagnosis: primary: salicylate and tylenol overdose. secondary: depression, bipolar disorder discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking care of you at the . you were admitted following an overdose on aspirin and tylenol, following which you became obtunded and developed severe metabolic abnormalities. you were cared for in our intensive care unit, where you required aggressive treatments and dialysis to remove aspirin from your body. . you also had some liver damage from the tylenol, for which we treated you with n-acetylcysteine to remove tylenol from your body. . while your mental status was poor, you likely inhaled some secretions into your lung and developed an aspiration pneumonia. you were started on antibiotics for this, and will need to complete a course of levofloxacin following discharge. . once we stopped fluid treatments for your overdose, we noticed that the sodium level in your blood was high. blood and urine tests suggested that this is probably a condition called "nephrogenic diabetes insipidus" a condition in which the body makes excess amounts of dilute urine and causes the sodium level in the blood to rise. this is a consequence of your long-term lithium use. an ultrasound scan of your kidneys showed some cysts in your kidney, which may also be related to lithium. it is important that you keep yourself well-hydrated by drinking plenty of water. you will need to followup with nephrology as an outpatient. . now that you have medically recovered from aspirin and tylenol poisoning, you will need further treatment in a psychiatric facility. . we made the following changes to your medications: stopped lithium stopped citalopram stopped clonazepam stopped glycopyrrolate . started levofloxacin last date started pantoprazole started miconazole powder followup instructions: at the time of dicharge from inpatient psychiatry, please arrange followup with the patient's primary care practitioner, nephrology (dr. , ), and psychiatry (dr. at ). procedure: hemodialysis venous catheterization for renal dialysis central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified other chronic pain anemia, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified paralysis agitans hypotension, unspecified pneumonitis due to inhalation of food or vomitus osteoarthrosis, unspecified whether generalized or localized, site unspecified altered mental status hyperosmolality and/or hypernatremia spinal stenosis, unspecified region poisoning by aromatic analgesics, not elsewhere classified suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics hepatitis, unspecified nephrogenic diabetes insipidus other psychotropic agents causing adverse effects in therapeutic use mixed acid-base balance disorder poisoning by salicylates unspecified episodic mood disorder tachypnea major depressive affective disorder, recurrent episode, unspecified 

Answer: The patient is high likely exposed to