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: overdose major surgical or invasive procedure: central venous line placement hemodialysis fasciotomy history of present illness: 40 yo m w/ unknown pmh p/w drug overdose. the patient was found down with empty bottles of tramadol, fiorcet (butalbital, apap, caffeine), and lorazepam. he was intubated in the field. . in the emergency department he was hypotensive to 60-80s sbp. he received 5l ivf, and sbp came up to 100-110s/60s; his heart rate was in the 110s and came down to 90s with fluids. he was afebrile. tox screen was positive for acetaminophen (5.6) and benzodiazepines, negative for ethanol. toxicology service was consulted. he also had cool lle, and vascular was consulted for compartment syndrome. he had 18g ivs placed, and was given charcoal via ngt. he also received vancomycin and zosyn for hypotension and elevated wbc count. . past medical history: pmh: htn . psych hx: depression. pt admits to prior overdose ~10 yrs ago, when asked about past psych admissions he says 'i don't remember'. he was seeing a therapist in , , but stopped about 1 mo ago. seroquel had been prescribed by pcp. social history: please see social work notes for full details. in brief, the patient's wife informed the social worker that the patient had been having a long struggle with substance abuse and depression, and had been taking marijuana, benzodiazepines, and percocet, as well as "possibly suboxone". patient had been kicked out of his house by his wife and was living next door with his 22 year old daughter and her boyfriend when he made his suicide attempt. the family owns an engraving business. family history: unknown physical exam: 95.9 135/85 106 98% on ac 100% 550x14 5 sedated, nad perrl, eomi, no lad, mm dry skin: scratch marks on forehead, groin, leg chest: ctabl heart: rrr, no m/r/g, nl s1 s2 abd: soft, nt, nd, no hsm, bs + extr: lle in bandage s/p fasciotomy, rle dusky, distal pulses doppleable b/l pertinent results: admission labs: 06:00pm wbc-30.2* rbc-6.65* hgb-20.8* hct-61.3* mcv-92 mch-31.4 mchc-34.0 rdw-12.9 06:00pm plt count-466* 06:00pm glucose-160* urea n-30* creat-3.6* sodium-137 potassium-7.4* chloride-103 total co2-7* anion gap-34* 06:00pm calcium-8.1* 06:00pm alt(sgpt)-538* ast(sgot)-1523* alk phos-80 tot bili-0.6 06:00pm amylase-131* 06:00pm pt-13.6* ptt-31.1 inr(pt)-1.2* 06:20pm ck(cpk)-* 06:00pm asa-neg ethanol-neg acetmnphn-5.9 bnzodzpn-pos barbitrt-neg tricyclic-neg 06:20pm urine bnzodzpn-pos barbitrt-pos opiates-neg cocaine-neg amphetmn-neg mthdone-pos . . liver enzymes and ck course in the first portion of admission: 06:20pm blood ck(cpk)-* 09:10pm blood ck(cpk)-* 06:01am blood ck(cpk)-* alt-553* ast-1454* ld(ldh)-3040* alkphos-46 totbili-0.2 03:59pm blood ck(cpk)-* alt-510* ast-1371* ld(ldh)-2628* alkphos-46 totbili-0.4 03:16am blood ck(cpk)-* alt-524* ast-1383* ld(ldh)-2332* alkphos-51 totbili-0.3 03:16am blood ck(cpk)-* alt-524* ast-1383* ld(ldh)-2332* alkphos-51 totbili-0.3 04:31pm blood ck(cpk)-* 09:30pm blood ck(cpk)-* 05:30am blood ck(cpk)-* alt-514* ast-1379* ld(ldh)-2227* alkphos-62 amylase-91 totbili-0.5 06:40am blood ck(cpk)-* alt-383* ast-733* ld(ldh)-1441* alkphos-71 totbili-0.4 06:32am blood ck(cpk)-* alt-303* ast-359* ld(ldh)-955* alkphos-106 amylase-121* totbili-0.3 05:11am blood ck(cpk)-7544* alt-208* ast-174* ld(ldh)-726* alkphos-90 totbili-0.3 10:09am blood ck(cpk)-5785* alt-167* ast-123* ld(ldh)-690* alkphos-73 totbili-0.3 04:03am blood ck(cpk)-790* alt-60* ast-30 ld(ldh)-375* alkphos-50 totbili-0.2 05:30am blood ck(cpk)-306* alt-19 ast-24 alkphos-93 totbili-0.2 brief hospital course: this is a 44 year old man who was found down and brought in by ambulance after a poly-pharmacy overdose suicide attempt, with his subsequent course complicated by initial respiratory failure and intubation in the field, followed by compartment syndrome, rhabdomyolysis, and renal failure. the patient is 44 year old male c severe depression s/p drug overdose suffering from rhabdo causing a resolving arf, now hyperca resolving, s/p fasciotomies for compartment syndrome, healing well. . #overdose (medical issues): it was not clear exactly which drugs the patient overdosed on. reportedly benzo/fiorecet/tramadol were found. tox screen was positive for benzo/barbs/tylenol/methadone. after obtaining collateral info, it appears that the pt was taking large quantities of benzodiazepines and percocet/subuxone daily. tylenol level in the ed was elevated at 5.9. the patient was started on a nac protocol in ed (150mg/kg over 1hr, then 50mg/kg over 4hrs, then 100mg/kg over 16hrs). pt was also found to be tachycardic and hypertensive and was started on a ciwa scale with valium for suspected benzodiazepine withdrawal. the patient was also started on a fentanyl patch with taper for possible narcotic withdrawal. he was supplemented with thiamine, folic acid, pyridoxine. psychiatry was consulted and followed him throughout the admission (see below). . # severe depression, suicide attempt: during much of the admission, the patient was sleepy (early on, to the point of ongoing sedation in the context of a fair amount of pain and pain medication), flat of affect, and not particularly communicative. as the admission progressed in mid- the patient was more awake and mildly communicative. he had poor appetite and in the context of trying to improve his po intake, we started remeron. the patient's appetite and mood appeared to improve slightly although this was doubtlessly also associated with resolution of some of his medical and surgical issues. . mr required a 1:1 sitter throughout much of his admission and continued to express his concern that he would not be safe alone without a sitter. however as he improved from a medical standpoint, he made gradual strides in his mood and concern for his own safety. for the last week of his hospital stay, he continued to state that he felt safe without 1:1 observation. he was started on remeron in part for appetite and also for mood; psychiatry followed along. per recommendation of the psychiatry consult service, he should be followed in the rehab facility for additional psychiatry support and medication titration. he no longer requires a 1:1 sitter, and has been discontinued, as per psych recs. . at the time of discharge, he was on mirtrazipine 30mg po qd and lorazapam 1mg po q6h prn anxiety as per psych recs. . #compartment syndrome in ble: vascular surgery was consulted in the ed and performed lle fasciotomy in 4 compartments on night of admission as well as a rle fasciotomy on . he received perioperative vancomycin for prophylaxis. he developed significant rhabdomyolysis with the ck trend detailed above in the "labs" section, which was likely the major contributor to his acute renal failure (see below). vascular surgery continued to follow this patient closely, with the following notable interventions: : lle fasciotomy in 4 compartments night of admission () : rle fasciotomy : bilateral additional lateral fasciotomies and additional debridement. : additional debridement, with some dead muscle seen but appeared to be mostly well. placement of wound vacs. was kept overnight in the vascular intensive care unit for monitoring for concern for effects of reperfusion of possible necrotic tissue; was stable overnight and transferred back to the medicine service in the morning. he remained stable on the medical floor thereafter. : vac change. : repeat vac change. : skin grafting to all but one fasciotomy site (lateral left). : removal of vacs and evaluation of grafts. : skin grafting of the remaining fasciotomy site. all skin grafts were taken from regions of thigh skin. he should follow-up in the vascular surgery clinic as recommended in the discharge instructions. wound care for the incisions include adapetec dressings and ace bandages. the incisions were clean, dry, and intact, at the time of discharge. - pain management has been an issue as the patient has significant tolerance to opiates and benzos. on discharge, the patient was on a fentanyl 100mcg patch and oxycodone 15mg po q3h, with the patient requesting around 40mg daily and still in visible distress upon movement. . - daily dressings, adaptec, ace bandages. -pain - the pain is well controlled at every time i ask, con't current medications - oxycodone -fentanyl 100mcg -morphine was d/c'ed to reduce polypharmacy -morphine 2mg x1 was given this morning, oxycodone 40 was taken over the day yesterday and 20mg this morning, the prn dose was increased to 15mg q3h. . #acute renal failure: clinical course most consistent with atn secondary to rhabdomyolysis, possibly also with an element of overdose drug-related injury; and dehydration likely contributing a prerenal element. renal was consulted and followed closely. mr was on hemodialysis through . he was kept on sevalamer for phosphate. gradually he experienced renal recovery and no longer needed hemodialysis. his discharge serum creatinine was 1.7. it is expected that this may be the patient's new baseline as it is unlikely that the patient will recovery complete renal function. . # hypercalcemia: the patient developed hypercalcemia during his period of renal recovery. this was attributed to mobilization of precipitated calcium salts in the inflammed muscles during his rhabdomyolysis. the patient received calcitonin in addition to iv fluids and lasix. - as per renal recs today, d/c lasix and calcitonin and to continue fluids for one more day. ensure that cr and ca levels are stable or dropping. reconsider lasix and fluids if cr and ca levels being to rise. - as the kidney function improves, the patient should be able to independently maintain a negative fluid balance. . #c diff colitis: c diff b detected; enterobacter detected from a tissue culture from a debridement; and pan-sensitive e coli was seen in his urine on the 24th. otherwise all of his repeated cultures were negative. in the micu, while febrile and critical, he was treated with vancomycin and cefepime empirically. he was treated empirically and perioperatively with vancomycin starting on . his e coli was treated with ciprofloxacin from ; this was changed to cefepime because of fever. on cefepime was changed to meropenem after his enterobacter was detected, with concern for likelihood of development of esbl on a cephalosporin. meropenem and vancomycin were discontinued on . he was on initially empiric flagyl from because of abdominal pain and loose stools in the setting of broad-spectrum antibiotics, and now is scheduled to stop on (7 days after the discontinuation of vancomycin and meropenem). he was on and off po vanc; we found after several attempts that when we pulled po vanc he was more likely to be febrile, more likely to have an elevated white count, and more likely to have abdominal pain; furthermore, c diff b toxin was detected on and gave further argument for aggressive c. diff treatment. po vanc was stopped on . at discharge, the patient had solid stools and was afebrile. . the sources of his fevers were generally not clear; some may have been secondary to tissue trauma and reperfusion, or to drug effects. after meropenem and vancomycin were discontinued on , he has had fewer fevers since. . #transaminitis: this is likely from hepatic injury from od including tylenol and shock liver from hypotension (it was unclear how long the patient was down). hepatitis serologies for b and c returned negative. this resolved over the earlier part of the admission. his coags began elevating around and his inr reached a peak of 3.5; this resolved, lagging behind his resolving liver enzymes, confirming the observation of a brief time of liver dysfunction followed by resolution. . #hypertension and tachycardia: mr was hypertensive early in the admission as well as tachycardic. this was initially thought perhaps secondary to benzo withdrawal but continued beyond an expected course for this; pain may have been the more significant contributor. he was started on metoprolol which was titrated up to 75 tid. he had no ectopy. he was normotensive with high normal heart rates on metoprolol. as his pain resolves and his mood lightens, it will likely be useful to titrate this down. . #shock: initially the patient was hypotensive to 60s in the ed. this was likely secondary to dehydration--sbp came up with ivfs--as well as ingestion of sedative agents. he was not clearly infected. he did receive vancomycin and zosyn in ed and vanco for prophylaxis for fasciotomy. bcxs, ucx were all ngtd. cxr was without infiltrate. . #metabolic acidosis: initially, ag = 27, with delta:delta about 1, suggesting pure anion gap metaboic acidosis. this was likely secondary to renal failure. osmolal gap was 3, so methanol and ethylene glycol poisoning was felt to be unlikely. this resolved with aggresive ivf resuscitation with isotonic bicarbonate. . #gi bleed: bright red blood per rectum was observed on and on . gi was consulted. he had a rectal tube at the time and subsequent clinical observations, most especially the eventual resolution of bleeding after pulling the rectal tube on , suggested that a tissue ulceration associated with the rectal tube was most likely to be responsible. this issue has been resolved prior to discharge. . #anemia: anemia of chronic disease. most consistent with anemia of inflammation combined with blood loss from graft sites, and briefly from gi bleeding. he was transfused with a total of 5 units of prbcs over the admission. he was transfused for hct <21 or at dialysis for values close to 21. he was started on iron supplementation and epoeitin for support of blood cell production starting on . his need for epogen would be expected to decrease as he continues to experience renal recovery. - as per renal rec and iron studies epoetin alfa and ferritin was d/c'ed on . . #ppx: heparin sc. bowel regimen as needed. . #fen: from to , he was on tpn; his ileus, sedation and pain seemed to preclude him tolerating much po intake. eventually he was able to eat more and we decreased and then eliminated tpn. he was tolerating a full diet with supplements. . #social: social work followed closely. mr wanted his parents to be the main contacts and also decisionmakers when he did not have the capacity to make decisions. . #code: full . #communication: with parents and patient . medications on admission: unknown discharge medications: 1. line care picc line care per protocol 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day) as needed. 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 6. lorazepam 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed for nausea. 7. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once (once) for 1 doses. 12. oxycodone 5 mg tablet sig: three (3) tablet po q3h (every 3 hours) as needed for pain. 13. picc line care protocol 14. furosemide 10 mg/ml solution sig: one (1) injection (2 times a day). 15. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). 16. multivitamins tablet, chewable sig: one (1) cap po daily (daily). 17. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 18. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for breakthru nausea. 19. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. discharge disposition: extended care facility: discharge diagnosis: primary: drug overdose suicide attempt rhabdomyolysis bilateral lower leg compartment syndrome acute renal failure requiring hemodialysis depression c. dif colitis secondary: hypertension discharge condition: stable. improving renal function. not requiring 1:1 observation. max assist on transfers. discharge instructions: if cr >1.4, send to nephro service, steimnan you were admitted with drug overdose causing your compartment syndrome requiring surgery for your calves and causing your kidneys to shut down. to help your kidneys, you were placed on hemodialysis, but since, you have recovered function and no longer need diaylsis. your volume overload and hypercalcemia issues are resolving as your kidney functions improves. please do not use illicit substances and comply with your medications. please go to all scheduled follow up appointments with your physicians. if you feel that your condition is worsening or acutely ill, contact your pcp or go to the emergency room. followup instructions: vascular surgery clinic: please have someone call ( to inquire about a follow-up appointment with dr. within 4-6 weeks. clinic: please have someone call ( to schedule a follow-up appointment with dr. within 4-6 weeks. please also see your pcp as scheduled and inform of the updates to your medical history. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances hemodialysis other skin graft to other sites other skin graft to other sites other myectomy other myectomy other immobilization, pressure, and attention to wound other incision of soft tissue other incision of soft tissue diagnoses: acidosis anemia of other chronic disease acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension acute and subacute necrosis of liver suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents poisoning by benzodiazepine-based tranquilizers acute respiratory failure intestinal infection due to clostridium difficile dehydration poisoning by aromatic analgesics, not elsewhere classified suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics drug withdrawal rhabdomyolysis hypercalcemia other disorders of muscle, ligament, and fascia poisoning by methadone nontraumatic compartment syndrome of lower extremity major depressive affective disorder, recurrent episode, unspecified sedative, hypnotic or anxiolytic dependence, unspecified poisoning by barbiturates suicide and self-inflicted poisoning by barbiturates 

Answer: The patient is high likely exposed to