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: celexa attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: 50yom w/ hcv/etoh cirrhosis s/p olt in w/ recidivant etoh use and resulting cirrhosis of liver graft c/b ascites, encephalopathy, and jaundice presented to osh on with 3-4 days of increasing confusion and disorientation. pt using remote control as telephone and turning on stove and forgetting. told wife that something wrong with him and taken to ed. also wife said she was worried b/c she thought he was taking too much verapamil. patient also w/ new scratch on chin, but not sure how he got it so worried he had fallen). per report, patient had been taking the wrong amount of verapamil for unknown reasons (240mg , rather than actual dose of 120mg daily vs 120mg ?), and was bradycardic upon arrival to the osh. at the osh, he received epinephrine and aptropine. he is currently in nsr at a rate of 80's with blood pressures in 100's/60's. . he is intubated for airway protection. he was tried on cpap yesterday, but then switched back to ac reportedly because of acidosis with a gas of 7.20/42/90/15, poor ms, ?volume overload, ? restrictive defect assoc w/ ascites. his current vent settings are ac 450x16, peep 5, fio2 40%. he is on propofol for sedation. per nursing report, they are suctioning thick secretions from the et tube, though he remains afebrile. sputum sample was sent from hospital and is pending. wbc this am was 11.8. . also at the osh, noted to have new renal failure with creatinine peaking at 4.0, with todays creatinine at 3.2. his baseline is 0.8. most recent lft's from today are alt 291, ast 83, tbili 3.4, ap 136. . also, pt noted to have hct of 22 on admission. he has received 2 units prbc's, now with a stable hct (27.9 today, baseline is 28-30). per report, no h/o melena, coffee grounds on flushing of ngt or hematochezia. as part of his workup for the low hct, he had ct a/p, which showed ? sbo. he had decompression with ngt, and has been stooling. he is receiving lactulose q2 hours. . he has a triple lumen in the l subclavian currently. . currently pt is intubated, but calm. nods his head no when asked if pain/complaints/cough/fever/abdominal pain. other history obtained from medical records, nursing communication, and wife. past medical history: - etoh/hcv cirrhosis c/b recidivant etoh cirrhosis c/b ascites, jaundice, and encephalopathy; s/p liver ; known splenic varices - following , anastamotic stricture (cbd stenosis s/p ercp and stenting in ) - recurrent hcv in graft, started on interferon but developed thrombocytopenia and discontinued - hypertension - diabetes mellitis, type 2 - itp s/p splenectomy - depression social history: married with one son. history of etoh abuse in past was sober then relapsed. has been drinking 1 pint of vodka intermittantly. last drink was 4 months ago per most recent note in in omr. no tobacco or other drug use. family history: mother died of "intestinal cancer". father died of cirrhosis. physical exam: general: intubated, follows commands heent: sclera icteric b/l, mmm neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally in anterior fields cv: regular rate and rhythm, normal s1 + s2, 3/6 systolic murmur abdomen: well-healed surgical incisions, liver edge palpable, no ascites appreciated. excellent bowel sounds, soft. no ttp and no rebound/guarding. ext: warm, well perfused, 2+ dp pulses, no edema b/l pertinent results: labs on admission: 09:52pm type-art rates-/12 peep-5 o2-40 po2-117* pco2-25* ph-7.40 total co2-16* base xs--6 intubated-intubated vent-spontaneou 09:29pm lactate-1.5 09:08pm glucose-137* urea n-62* creat-2.5*# sodium-128* potassium-3.2* chloride-101 total co2-16* anion gap-14 09:08pm alt(sgpt)-82* ast(sgot)-243* ld(ldh)-490* alk phos-145* tot bili-3.6* 09:08pm wbc-9.7 rbc-3.64* hgb-9.0* hct-28.0* mcv-77*# mch-24.8* mchc-32.3 rdw-20.8* 09:00pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 09:00pm urine rbc->50 wbc-0-2 bacteria-occ yeast-none epi-0-2 imaging: cxr findings: in comparison with the study of , there is an endotracheal tube in place approximately 3 cm above the carina. nasogastric tube is coiled within the upper stomach. low lung volumes may contribute to the increased prominence of the cardiac silhouette. there is poor definition of an apparently engorged pulmonary vessels, consistent with increased pulmonary venous pressure, though respiratory motion may be enhancing this appearance. opacification in the retrocardiac region is consistent with atelectasis, though the possibility of supervening pneumonia would have to be considered in the appropriate clinical setting. . ruq us (): 1. persistent reversal of flow within the portal veins. 2. the right and left hepatic veins were not well visualized. the middle hepatic vein appears patent. 3. liver cirrhosis with areas of increased echogenicity, unchanged. 4. persistent pneumobilia. 5. moderate amount of right lower quadrant ascites. small amount of fluid in the left lower quadrant. 6. surgical absence of the spleen. . tte (): the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). a mid-cavitary gradient is identified. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the left ventricular inflow pattern suggests impaired relaxation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr (): mild vascular congestion and small right effusion. no acute change post-extubation brief hospital course: 50 year old male with hepatitis c/alcohol cirrhosis s/p olt in with recidivant etoh use and resulting cirrhosis of liver graft complicated by ascites, encephalopathy, and jaundice presented to osh on with one week of increasing confusion which led to verapamil overdose, complicated by hypotension, bradycardia, acute renal failure and intubated for airway protection. 1. respiratory failure/airway protection: gas at osh on cpap suggested metabolic acidosis, likely in the setting of renal failure. he was intubated also to protect his airway. initial cxr at osh showed concern for pneumonia with bronch stain showing gram positive cocci in pairs. he was empirically started on vancomycin/zosyn and completed 8 days of antibiotics. he was extubated on with no complications. 2. acute renal failure: likely due to atn in the setting of poor forward flow due to bradycardia/hypotension reported at osh. creatinine returned to baseline of 1.0 prior to admission. 3. encephalopathy: initial insult could be community acquired pneumonia for which he got 8 days of iv antibiotics. ct head at the osh was negative along with urine tox screen. his wife reported compliance with his medications. blood and urine cultures have been negative at osh and here. ruq showed patent vasculature while mild-moderate ascites was never tapped for sbp. his encephalopathy resolved on the floor which was confirmed with his wife. 4. ? small bowel obstruction per osh report: he was noted to have appropriate bowel movements and had benign abdominal exam. 5. anemia: likely due to acute renal failure. no signs of acute gi bleed. had stable hematocrit around his baseline of 28.0. 6. hepatitis c/alcohol cirrhosis s/p with decompensated cirrhosis due to alcohol use and recurrent hepatitis c. meld of 23. did not tolerate interferon due to thrombocytopenia in the past. last drink per patient five months ago. continued lactulose and rifaximin for encephalopathy. tacrolimus was held for four days and restarted at home 0.5 mg po qdaily with goal of levels between 4 and 6 nadolol 20 mg po qdaily was continued. 7. diabetes mellitus type 2: was noted to be hyperglycemic in the micu with glucose in 190s. increased bedtime lantus insulin dose to 25 units which is still less than 33 units he takes at home. 8. hypertension: continue verapamil 40 mg po q8. confirmed with dr. that he was on verapamil xr 240 mg po qdaily. discharged on the latter dose. home hydrochlorothiazide was not added as his blood pressure did not tolerated it. 9. depression: trazodone and sertraline were held due to his altered mental status but restarted sertraline on discharge with appropriate mental status. 10.hyperlipidemia: pravastatin 10 mg po qdaily was held due to elevated liver enzymes. restarted upon discharge. 11. bradycardia/hypotension at osh: responded to atropine, epinephrine and intravenous fluids. medications on admission: medications per last dc summary and clinic notes: 1. omeprazole 20 mg daily 2. pravastatin 10 mg daily 3. sertraline 50 mg daily 4. tacrolimus 0.5 mg q24 daily 5. trazodone 25mg po hs. 6. verapamil 120 mg sr q24 vs 120mg 7. calcium carbonate 500 mg . 8. cholecalciferol (vitamin d3) 400 unit . 9. magnesium oxide 400 mg po tid. 10. lantus 100 unit/ml solution sig: 33 units sc qhs. 11. humalog 100 unit/ml solution sig: sliding scale sc qid. 12. hydrochlorothiazide 25 mg tablet sig: one tablet po daily. 13. lactulose 30ml tid discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 2. pravastatin 10 mg tablet sig: one (1) tablet po once a day. 3. sertraline 50 mg tablet sig: one (1) tablet po once a day. 4. verapamil 240 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 5. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po twice a day. 6. vitamin d-3 400 unit capsule sig: one (1) capsule po twice a day. 7. magnesium oxide 400 mg tablet sig: one (1) tablet po three times a day. 8. lantus 100 unit/ml solution sig: twenty five (25) units subcutaneous before dinner. 9. insulin humalog please continue your previous sliding scale with meals 10. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 11. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 12. tacrolimus 0.5 mg capsule sig: one (1) capsule po once a day. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis 1. encephalopathy 2. community acquired pneumonia 3. hypotension and bradycardia from accidental verapamil overdose discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the outside hospital because you were noted to be confusion and overdosed on your verapamil. you were found to have low blood pressure and heart rate along with acute kidney injury which responded to atropine, epinephrine and intravenous fluids. you were started on vancomycin and zosyn for bacterial pneumonia. you were transferred to intensive care unit where your blood pressure remained stable and your confusion resolved. . following medication changes were made to your home regimen. please take your medications as directed. stop trazodone 25 mg by mouth before bedtime stop hydrochlorothiazide 25 mg by mouth daily due to low blood sodium levels decrease lantus to 25 units before dinner to make sure your sugar levels are stable when you go home start rifaximin 550 mg by mouth twice a day for confusion . please only take 240 mg once a day of verapamil. taking too much will make you sick again. followup instructions: name: ,md specialty: primary care address: , , phone: when: monday, at 3:00pm procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnoses: pneumonia, organism unspecified acidosis acute kidney failure with lesion of tubular necrosis unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver hyposmolality and/or hyponatremia depressive disorder, not elsewhere classified atrial flutter acute respiratory failure other specified cardiac dysrhythmias liver replaced by transplant alcohol abuse, continuous other specified anemias other specified hypotension poisoning by other and unspecified agents primarily affecting the cardiovascular system accidental poisoning by agents primarily affecting cardiovascular system 

Answer: The patient is high likely exposed to