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: history of present illness: this is a 23-year-old female with history of depression with previous suicide attempt, who was transferred from an outside hospital after presenting there today with change in mental status and unresponsiveness. tox screen at that time was positive for cocaine, benzodiazepines, and tylenol. per the family report, the patient went out partying saturday night and returned sunday at noon. the patient was not "feeling well" at that time and slept for most of the day. this was not untypical of the patient's weekend behavior. however, today, she continued to experience similar vagueness, increased thirst, and excessive sleepiness. the patient's family left her at home to rest and when they returned, found her agitated, unresponsive, and called ems. the patient was initially brought to . at the outside hospital, the patient remained agitated with fingersticks around 35-32, gave her an amp of d50 with narcan. the patient awoke slightly and complained of a headache at that time. then mental status deteriorated, and the patient was intubated secondary to agitation. ct of the head was negative. the patient was given 2 g of ceftriaxone. white blood count was found to be 24.5, ast 1574, alt 1363, total bilirubin 2.7. an abg at that time showed ph of 6.85, pco2 of 29 and pao2 of 113. her tylenol level was 50. her urine tox screen was positive for cocaine. the patient was given n-acetylcysteine by mouth x 1. past medical history: notable for depression. the patient has been hospitalized at age 16 for suicide attempt with aspirin overdose. attention deficit disorder. status post c-section. the patient is g1 p1. allergies: no known drug allergies. medications on admission: 1. wellbutrin. 2. zyprexa. social history: positive alcohol, positive tobacco of 1 pack per day, positive cocaine. the patient has a 4-year-old son at home. family history: the patient is adopted. physical examination: vital signs on presentation: temperature 98 degrees, blood pressure 95/50, heart rate 130, breathings 30, 88 percent o2 saturation. the patient was intubated, sedated, and currently on paralytics. heent: pupils equal, round, and reactive to light, although minimally responsive. neck: c-collar in place. cardiovascular: regular rate/tachycardic, s1, s2, no murmurs, rubs or gallops. lungs: decreased crackles bilaterally. abdomen: slightly distended but normal bowel sounds, soft, unable to appreciate rebound. no guarding secondary to paralytics. extremities: without cyanosis, clubbing or edema, warm to touch. neurologic: unable to asses neurologic exam secondary to sedation and c-collar. however, again, pupils equal, round, and reactive to light. laboratory data on admission: notable for a white count of 22.1, hematocrit 32.8, platelets of 217,000. chemistries: sodium 144, potassium 5.6, chloride 118, bicarbonate 8, bun 12, creatinine 1.1, glucose of 88, anion gap 18, calcium 6.8, magnesium 2.1, phosphorus 2.3, alt 1210, ast 1471, ldh 1189, amylase 1273, lipase 63. abg was 7.13, 24, 315 on ventilator settings of assist control 500/14, 100 percent fio2 and peep of 5. lactate was 9.7. tylenol level was 34, down from 50. at this time, serum tox screen was negative. urine tox positive for benzos and cocaine. pt, ptt and inr were 35.5, 49.4 and 8.9. radiographic studies: ekg showed sinus tachycardia in the 130s, normal intervals and axis, no evidence of acute ischemia. chest x-ray number 1 showed questionable right perihilar haziness, questionable infiltrates. chest x-ray 2 performed approximately 8 hours later showed diffuse bilateral infiltrates with positive bilateral pleural effusions. right upper quadrant ultrasound also performed at that time showed enlarged liver without biliary dilatation, edematous gallbladder but not distended and without calculi. dopplers of portal vein flow showed patent veins, patent hepatic arteries, no evidence of hydronephrosis, no evidence of splenic enlargement. again, this is a 23-year-old female with history of depression, previous suicide attempts with history of polysubstance abuse, now presents as transfer for change in mental status and agitation requiring intubation and paralytics. notable findings are for elevated tylenol level and elevated transaminases with profound acidemia and elevated anion gap. hospital course by problems: liver failure: initially, differential included tylenol overdose, viral hepatitis and ischemic injury from being found down. however, report is that the patient ingested only 12 tablets of tylenol. again, actual dose is unknown; however, tylenol levels are still elevated. the patient was seen by the hepatology service acutely that night and was started on n-acetylcysteine at 17.5 g per hour as a continuous drip. the patient's hep serologies were checked and found to be negative. again, ultrasound was checked and found to be negative for any portal vein thrombosis or acute abdominal catastrophe. the patient's fingerstick was monitored every 1 hour for acute changes in the setting of liver failure. the patient was given a d5 half-normal saline drip for support. inr was checked every 4 hours. lfts and bilirubin were checked daily. throughout the hospital course, the patient's lfts continued to rise and ast peaked at 12,681, alt peaked at 7,500. during this course, thoughts of liver transplant was initially discussed. the patient was, the next day, seen by transplant psychiatry service. however, given her past suicidal attempt and polysubstance abuse, the patient was deemed to be not a candidate for liver transplant. therefore, supportive care was aggressively maintained throughout her hospitalization. as the tylenol level returned to zero, the patient was still continued on n- acetylcysteine per request of toxicology consult given the fact that she may be retaining some of the medication in her peripheral tissues. the patient's coagulopathy persisted, although her lfts began to decline. ultimately, the patient succumbed to the acute insult and her liver was well within the setting of multisystem organ failure. hypoxia: the patient was aggressively fluid resuscitated; however, became hypoxic secondary to pulmonary edema initially in the emergency department. the patient's ventilator settings were adjusted to maintain lung protective strategies and decrease lung injury. there was evidence of ards by chest film and by po2 to fio2 ratio. the patient was enrolled in a balloon esophageal study to optimize peep. the patient was continued on these lung-protective strategies. oxygenation and ventilation were maintained on paralytics. however, after discontinuing paralytics, the patient was found to be breathing over the ventilator continually and therefore was maintained on paralytics. this presented difficulty in clinically assessing the patient, as it was unable to assess the mental status while on significant sedation, as well as her abdominal exam while on paralytics. acidosis: the patient's anion gap metabolic acidosis was likely secondary to lactic acidosis from her liver injury. the patient remained extremely acidotic for multiple days after presentation. the patient was ultimately started on a bicarbonate drip to correct her acidosis, electrolytes repleted as needed. osmolal gap was checked; however, there were no significant findings. hypotension: the patient was initially started on a neo- synephrine drip for concern for hypovolemia versus sepsis. the patient was given aggressive fluid resuscitation as well as started on pressors to maintain her blood pressures. throughout the hospital course, the patient did spike temperatures, however, blood cultures were negative. at the time of expiration, patient's blood cultures grew out e. coli. this may have been an infection the patient developed in the hospital as opposed to at home. however, of note, these cultures did not grow until after the patient's death. poor urine output: despite iv fluid hydration, urine output remained poor. the patient's picture was more concerning for atn in the setting of tylenol toxicity versus hepatorenal syndrome. however, hepatorenal syndrome was less likely. multiple attempts were tried to improve urine output such as bolusing fluid, giving lasix. ultimately, the patient was started on cvvh to remove volume as the patient developed neurologic abnormalities, which i will discuss later. hospital day 1: the patient was started on neo-synephrine and then vasopressin to maintain blood pressures. the patient diuresed a liter on her own, central access was maintained. however, the patient became again hypotensive upon arrival to the intensive care unit. regarding her respiratory status on day number 1, ventilator settings were adjusted to optimize her ph. the patient was started on ceftriaxone and flagyl for concerns for aspiration pneumonia, and lung-protective strategies were maintained in the setting of ards. regarding her cardiac issues on day number 1, there was some concern for cocaine-induced mi. cardiac enzymes were checked and found to be positive; again this could be multifactorial secondary to cocaine-induced mi versus hypotension versus an arrhythmia in the setting of being found down. hospital day 2: the patient had a swan placed showing pa pressure 33/28, cardiac output of 6.1, svo2 of 73, and svr of 748 with a wedge of 15. this was thought to be consistent with distributive shock. on this day, the patient was started on alternate protocol and an esophageal balloon was placed for management of the ventilator. there was some concern for extravasation of neo-synephrine and the patient's left arm cyst was noted at the time of admission. however, it seemed to progress during the hospitalization, although patient was receiving all her pressors centrally; this may have occurred at the outside hospital. the patient was given injections of phentolamine to contain necrosis. on this day, the patient was weaned off of 2 of her pressors and continued on vasopressin. her lfts continued to rise. her acidosis began to resolve, but there were still significant difficulties with respirations. regarding her heme issues, the patient's hematocrit trended down slowly. there was some concern for hemolysis versus dic. the patient's inr was checked closely, fibrinogen was followed carefully; cryofibrinogen less than 100. hospital day 3: the patient then transfused 4 units of packed red blood cells overnight. the patient was started on lactulose initially to help with mental status in the setting of liver failure. however, there was some concern about inability to absorb oral intake secondary to gut edema. at this time, the patient was started on tpn for nutritional support. although the patient's hemodynamics began to stabilize and was weaned off pressors, the patient's respiratory status was still difficult to manage and the patient still on paralytics and significant sedation. hospital day 4: the patient had acute event of hypoxia when breathing over the ventilator. her sedation was increased, paralytics had been restarted, with evidence of increased pulmonary edema. bladder pressure was elevated. there was some concern for ascites, however, on ultrasound evaluation, there was no significant ascites to tap. later on that day, the patient's mean arterial pressures dropped into the 60s. the patient had no significant diuresis at that time; however, she was still thought to be volume overloaded. the patient was then started on levophed and that has improved. there was some concern for ekg showing low voltage; however, on review of previous ekgs, this has been unchanged. the slow decline in blood pressure was thought to be from excess sedation. on this day, tylenol level was 0 and n- acetylcysteine was stopped. again, later on in the day, toxicology requested that n-acetylcysteine be restarted secondary to retention of toxin in peripheral tissues. hospital day 5: the patient remained relatively stable; however, some concern for volume overload and dialysis versus cvvh was considered. the issues regarding this would be in the setting of hemodynamic stability. hospital day 6: on exam this morning, the patient's pupils were noted to be less reactive and questionably asymmetric. however, the patient demonstrated corneal reflexes and basic neurologic function. on this day, cvvh was initiated to help with overall volume status and gut edema. the patient still requiring large amounts of fluid and maintained on pressors to maintain blood pressure secondary to shock. this was thought to be septic shock versus distributive shock, not likely cardiogenic. there was some concern for uti; however, cultures at this time were negative to date. again, the patient was initiated on cvvh. later on in the afternoon, nursing staff noted the patient's pupils were more reactive. hospital day 7: at 2:45 a.m., house officer was called to evaluate the patient. the patient was hypothermic with labile blood pressure and heart rate. evidence of twitching of her eyes and her left arm. pupils were dilated at 5 mm bilaterally and nonreactive to light. corneal reflexes were absent. this was a significant change from exam prior in the day. there was high concern for increased cerebral edema and cerebral pressures in the setting of seizures versus herniation versus electrolyte changes. at that time, electrolytes were stable. a full set of laboratories were checked and were not significantly changed from the morning. the patient was given ativan to stop seizure activity. cvvh was decreased in the setting of hypotension; however, there was some consideration of starting a mannitol drip. however, in the setting of inability to diurese, mannitol was thought to be not as effective. family meeting was emergently held and the patient's family changed code status to dnr in the understanding that they did not want her to undergo massive brain surgery in the setting of high risk of bleeding in a high-risk patient. later on that morning, a family meeting was held with the attending physician, the thought was to ultimately withdraw care. the patient had an informal evaluation for brain death, cerebral perfusion scan was performed showing no blood flow to the brain. the family was understanding of this and organ donation became the next option. on , the patient expired. , procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis diagnoses: acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver other pulmonary insufficiency, not elsewhere classified depressive disorder, not elsewhere classified hypotension, unspecified cerebral edema paralytic ileus poisoning by aromatic analgesics, not elsewhere classified poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted 

Answer: The patient is high likely exposed to