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: altered mental status, loss of responsiveness major surgical or invasive procedure: none history of present illness: dr. is a 79 year old male with paroxysmal atrial fibrillation on warfarin, prior admissions for s. pneumo sepsis (), stage i colon ca s/p sigmoidectomy and hx of pulmonary fibrosis amiodarone who was transferred from rehab for decreased responsiveness and sleepiness. . patient continues to be drowsy and falls asleep frequently during the interview but is arousable. he remembers little about the past week, stating that he is "here to be evaluated for a lung transplant", but says he has been sleepier than usual over the past week. he denies dyspnea or pnd at any time during the past week. he also reports a "bad cough" productive of whitish sputum without hemoptysis. he denies fevers or chills, nausea/vomiting, night sweats, myalgias or any chest pain or pleuritic chest pain with the cough. in addition, patient states that he received a flu shot this season, and denied any sick contacts with colds or influenza in the rehab. . he also says that since he stopped amiodarone 2 months ago "my atrial fibrillation has not been well controlled", but denies any symptoms from it such as lightheadedness/dizziness, chest pain or dyspnea. . per nh notes, patient had "sundowning" for over 4 weeks with slight delirium and has been treated with risperidone increasing from 0.25mg to 1mg with no effect on his delirium. apparently pt had been brought to on for head ct and chest ct/cta for sob before his current admission on . . in the ed, patient was started on levo/flagyl for ?aspiration pneumonia, and also given 50mg metoprolol for rate control of his atrial fibrillation. he was given a trial of bipap which increased his o2 sat to 95% on 2l o2, but apparently did not decrease his hypercarbia/hypercapnia from pco2 = 60. he was switched to 2l nc with continued o2 sat of 95%, and transferred to the floor. . past medical history: 1. stage i t2m0 sigmoid colon adenocarcinoma, s/p lap () 2. s. pneumoniae sepsis, seeded from septic wrist () 3. paroxsymal atrial fibrillation formerly on amiodarone, unable to maintain sinus even with dc cardioversion, so amiodarone was discontinued due to possible lung toxicity. now on metoprolol+ diltiazem+digoxin and warfarin. 4. amiodarone related pulmonary fibrosis 5. spinal stenosis and sciatica 6. low back pain - hx of disc herniation at age 35 with surgery in recent past. 7. hx of melanoma on r chest s/p excision and extensive right axillary node dissection in 8. glaucoma 9. detached retina 10. dysphagia of unclear etiology, s/p peg 11. pacemaker ( enpulse) 12. ppd positive status per pcp, unclear 13. pseudogout (diagnosed on joint aspiration ) 14. etoh abuse 15. mrsa infection of the r olecranon bursa with associated cellulitis () 16. recent hx of pseudomonas uti treated with 7 day course of cefepime (per nh records) . past surgical hx: ================= 1. laparoscopic sigmoid colectomy for colon adenocarcinoma with bladder injury, no evidence of metastasis, stage i t2n0 (, dr. 2. i+d of l wrist abscess (, dr. social history: job: former chief of anesthesia for over 20 years at the hospital. living situation: he currently lives by himself and is able to live independently. his wife died of pbc. his son, chip, is a computer scientist who lives in and is his major support. he also has a daughter, age 40, who is a lawyer in . etoh: has prior etoh abuse issues per pcp, to drinking "1 drink a night" 6 months ago, but stopped due to illness. tobacco: quit smoking when he was 40 (~39 years ago), has 15 pack-year history prior. drugs: denies any illicit drugs. family history: father died at age 70 of dm, cva. mother died at age 85 of cva. son and daughter are healthy, patient denies family hx of cancer. physical exam: vs: t:98.2 , bp: 101/65, hr:110, rr:28, o2:952l gen: elderly man, sleepy, arousable, answers questions but falls asleep frequently during interview heent: ncat, dry mm, clear op, no exudates neck: supple, no lad, no jvp chest: cta bil cv: nml s1 s2 irregula, irregular no m/r/g abd: soft, ntnd, g tube in place without surrounding edema or eythema ext: no c/c/e 2+ dp pulses bilaterally neuro: a+o to place and month, language is fluent but often falls asleep, strength 4+/5 lue strength with 5/5 strength otherwise, sensation to light touch grossly intact, neg babinski pertinent results: admission labs: 08:30pm wbc-11.3* rbc-4.71# hgb-13.5*# hct-41.8# mcv-89# mch-28.6# mchc-32.3 rdw-14.9 08:30pm neuts-77.8* lymphs-14.2* monos-5.5 eos-2.4 basos-0.1 08:30pm plt count-335 08:30pm glucose-90 urea n-22* creat-0.7 sodium-131* potassium-4.8 chloride-89* total co2-39* anion gap-8 08:30pm alt(sgpt)-32 ast(sgot)-30 ld(ldh)-238 ck(cpk)-21* alk phos-165* amylase-98 tot bili-0.3 08:30pm lipase-41 08:36pm lactate-0.9 08:30pm pt-28.0* ptt-31.7 inr(pt)-2.8* brief hospital course: a/p: 79 yo m with pmh of paf, colon ca s/p sigmoidectomy, amiorodarone lung toxicity presenting with increased somnolence and found to be hypercarbic on abg. . #. hypercarbic resp failure: with input from pulmonology and nephrology, pt was felt to have a primary resp acidosis secondary to oversedation from ripseridol and tramadol. his respiratory acidosis improved off sedating medications. in addition, pt has underlying intertitial lung disease from amiodarone, which appears improved on cta. pt was initially treated with levo/flagyl for question of aspiration pneumonia which has been discontinued as pt does not clinically appear to have a pneumonia. he continues to clinically improve off antibiotics. pt still requires intermittent 1-2 l o2 by nc. pt will follow up with pulmonary as an outpatient. . # ms changes: ms changes probably multifactorial from hypercapnea and oversedation from medications. neurology was consulted. eeg was normal. they had also recommended lp; however, pt declined this procedure as his mental status improved. with his clinical improvement and lack of fever and other symptoms, deferring lp was not felt to be unreasonable. his mental status is now at/near baseline and he is currently alert and oriented x3. pt is to follow up with neurology at ecf. . # paroxysmal a-fib: pt was continued on coumadin, dilt, digoxin, and metoprolol. patient was briefly in the micu on because of borderline hypotension and afib with rvr to 140s. he had missed several doses of nodal agents because peg was clogged. his peg tube is now functional. hr is now controlled in the 80-100. . # transient hypotension: patient was briefly in the micu for hypotension, in setting of receiving diltiazem and lopressor to control his rvr. the hypotension had not responded to 1.5l of fluid boluses on the floor. he continued to receive fluids overnight and is now normotensive w/ systolics in 100s. he is off ivfs. . # leukocytosis: this appears to be chronic, though source is unclear. . # dysphagia: pt has a peg tube that was placed by ir 3 months ago. it had clogged on but is now functioning. speech and swallow evaluation, including video swallow, resulted in the following recommendations: 1. suggest a po diet of nectar thick liquids and soft consistency solids. 2. take liquids by straw. tuck your chin to your chest before you swallow. 3. take swallows for each bite and sip. 4. follow each bite with a sip of liquid. 5. pills crushed with purees. 6. continue with supplemental nutrition via the feeding tube as needed. consult nutrition for recommendations. . # decubitus ulcers: he was evaluated by wound care nursing. recommendations are: 1. pressure redistribution per pressure ulcer guidelines 2. turn and reposition q 2 hours and prn 3. foam cushion to chair when sitting 4. cleanse skin with gentle foam cleanser, pat dry, apply thin layer of critic aid with antifungal moisture barrier ointment. reapply after every 3 rd cleansing. . # comm: /hcp chip - cell( . # code status: full . # dispo: ecf medications on admission: 1. albuterol sulfate 2.5mg/0.5ml soln 1 neb qid 2. ascorbic acid 500mg tab 3. cyanocobalamin 500mcg tab daily 4. digoxin 0.125mg tab qt/th/s 5. digoxin 0.25mg tab qsu/mo/we/fr 6. diltiazem (cardizem) 60mg q0600/1200/1800/2200, hold for sbp <95, hr <60 7. guaifenesin 200mg po tid 8. ipratropium bromide 0.02% soln neb qid 9. lansoprazole 30mg daily 10. metoprolol tartrate 50mg , hold for sbp <95, hr <60 11. miconazole nitrate powder, to sacrum tid 12. nystatin 10ml po tid 13. risperidone 1mg po daily 14. sodium bicarbonate 8.4% vial 10cc with lansoprazole vt daily 15. thiamine 100mg tab vt daily 16. timolol maleate 0.25% drops, 1 drop to each eye 17. warfarin 2.5mg po daily 18. zinc sulfate 220mg capsule vt daily prn meds: 19. acetaminophen elixir 650mg/20ml vt q4h:prn 20. albuterol sulfate 2.5mg/0.5ml soln neb q4h:prn sob, wheezing 21. aquaphor healing ointment :prn for dry skin 22. ipratropium 0.02% soln q4h:prn for sob, wheezing 23. lactulose 20g/30ml cup vt daily:prn constipation 24. lidocaine patch 5% to back r lumbar, max 12 hours tp daily:prn pain 25. miconazole nitrate topical :prn rash 26. miracle cream (bacitracin, vit a&d, zinc oxide ointment) topical to sacrum tid:prn rash 27. risperidone 0.25mg po bid:prn confusion 28. tramadol 50mg po q8h:prn pain max dose 300mg/day 29. tramadol 25mg po q8h:prn pain max dose 300mg/day . discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) inhalation q4h (every 4 hours) as needed for wheezing/dyspnea. 3. zinc sulfate 220 mg capsule : one (1) capsule po daily (daily). 4. ascorbic acid 90 mg/ml drops : five hundred four (504) mg po daily (daily). 5. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 6. digoxin 50 mcg/ml solution : 0.125 mg po daily (daily). 7. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 10. warfarin 2.5 mg tablet : one (1) tablet po daily16 (once daily at 16). 11. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed. 12. diltiazem hcl 60 mg tablet : one (1) tablet po qid (4 times a day). 13. metoprolol tartrate 50 mg tablet : one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: & rehab center - discharge diagnosis: respiratory failure mental status changes paroxysmal atrial fibrillation transient hypotension dysphagia pressure ulcers discharge condition: stable, a&ox3 discharge instructions: you were admitted for increased somnolence. this is suspected to be due to the combination of risperidol and tramadol. your somnolence has greatly improved. neurology has been consulted. eeg was normal. you have declined to have a lumbar puncture; however, you are doing well clinically. please continue to take your medications as prescribed. please follow up with your physicians. followup instructions: please follow up with your primary care provider . within 4 weeks. his clinic number is . please follow up with dr. from pulmonology regarding your amiodarone toxicity with 2 weeks. his clinic number is (. please also follow up with neurology within 2 weeks. the clinic number is (. procedure: enteral infusion of concentrated nutritional substances diagnoses: acidosis other iatrogenic hypotension atrial fibrillation other opiates and related narcotics causing adverse effects in therapeutic use acute respiratory failure postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants pressure ulcer, lower back personal history of malignant neoplasm of large intestine gastrostomy status drug induced sleep disorders cardiac rhythm regulators causing adverse effects in therapeutic use other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to