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: heparin agents attending: chief complaint: s/p pea arrest major surgical or invasive procedure: endotracheal intubation triple lumen catheter - internal jugular vein triple lumen catheter - femoral vein femoral arterial line radial arterial line history of present illness: 37 yo m with bipolar and polysubstance abuse history presented from osh after being found unresponsive, intubated, complicated by cardiac arrest transferred to for further management. per patient's family, he was at his usual state of health, ate dinner with sister , had a bottle of beer. he picked up his prescription medication, moprhine and clonazepam. , his morphine dose is usually 60 mg. the patient apparently stated that he took 7 of his pills (unclear which). he went to bed and this was found to be drenched in sweat and unresponsive at 2pm on the day of arrival. he was sent to the osh. family did not notice any episodes of apnea. osh () record is incomplete at this time. patient had multiple pea arrest, recorded at 1746, 1750, 1755, 1810 and 1815; vt at 1800. underwent cpr and received multiple doses of epinephrine, 1x atropine, multiple amiodarone, 1x vasopressin, propofol, dopamine, heparin gtt, integralin, and other medications. apparently, the tox screen there showed + amphetamine, opiates, benzodiazepine, and ethanol. abg at 1533 was 7.20/47/379/18 on fio2 of 100, rr 14, cmv. in the ed, patient was initially thought to be hypotensive. he was on multiple pressors intiially- levophed, dopamine, dobutamine, phenylephrine. he received a femoral a line and femoral central line. he was found to be hyperkalemia with initial k up to 8, received insulin, calcium gluconate, and sodium bicarb. he was given vancomycin and zosyn given severe leukocytosis. patient was then transferred to get ct imaging prior to transfer, on only levophed. on the floor, patient was intubated review of systems: unable to assess past medical history: - depression - h/o suicidal attempts - h/o overdose - back pain - h/o penetrating eye injury - blindness in 1 eye - htn - mrsa - bipolar - hyperlipidemia - h/o h. pylori - h/o seizure social history: - tobacco: 2 ppd per family, for at least 15 years - alcohol: daily, per family family history: - non-contributory physical exam: admission: vitals: t:38.7 bp: 118/67 p: 101 r: 16 o2: 100% on ventilator general: intubated heent: sclera anicteric, mucous membrane dry, intubated neck: supple, no lad lungs: clear to auscultation bilaterally, + ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds diminished, no rebound tenderness or guarding, no organomegaly gu: + foley ext: cool, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge: vs - 97.5, 128/62, 75, 18, 96%ra general - well-appearing man in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no jvd, lungs - course breath sounds throughout, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nd, mild ttp, no masses or hsm, no rebound/guarding extremities - wwp, no cyanosis or clubbing, dp 2+ b/l, 2+ edema of all 4 extremities, +necrotic lesion on right thumb (unchanged). mass appreciated in left groin, ~7x4 cm, ttp, firm, nonpulsatile. left antecubital fossa: erythematous, non tender; improving. skin - no rashes or lesions neuro - awake, a&ox3, muscle strength 5/5, sensation grossly intact throughout, persistent flat affect with limited expression in his voice. pertinent results: admission: 07:55pm blood wbc-36.9* rbc-5.11 hgb-16.4 hct-50.2 mcv-98 mch-32.0 mchc-32.6 rdw-12.4 plt ct-335 02:05am blood neuts-84* bands-1 lymphs-12* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 07:55pm blood pt-15.6* ptt-63.1* inr(pt)-1.4* 07:55pm blood fibrino-236 11:00pm blood glucose-178* urean-33* creat-4.2* na-138 k-5.4* cl-104 hco3-18* angap-21* 07:55pm blood alt-1329* ast-1181* ld(ldh)-2620* ck(cpk)-* alkphos-95 totbili-0.7 07:55pm blood lipase-421* 07:55pm blood ck-mb-66* mb indx-0.2 ctropnt-0.82* 11:00pm blood calcium-7.5* phos-7.3* mg-1.9 07:55pm blood osmolal-309 07:55pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 09:02pm blood type-art temp-39.3 rates-/16 tidal v-600 fio2-100 po2-250* pco2-39 ph-7.26* caltco2-18* base xs--8 aado2-431 req o2-74 -assist/con intubat-intubated 08:03pm blood glucose-127* lactate-8.7* na-138 k-8.0* cl-103 calhco3-14* 09:02pm blood hgb-14.2 calchct-43 o2 sat-97 cohgb-2 methgb-1 09:02pm blood freeca-1.07* discharge: 06:45am blood wbc-10.3 rbc-2.99* hgb-9.5* hct-27.6* mcv-92 mch-31.6 mchc-34.3 rdw-14.0 plt ct-529* 06:45am blood pt-14.9* ptt-33.8 inr(pt)-1.3* 06:45am blood glucose-92 urean-15 creat-1.7* na-138 k-4.2 cl-106 hco3-23 angap-13 06:40am blood alt-45* ast-26 ld(ldh)-279* alkphos-100 totbili-0.4 06:45am blood calcium-8.6 phos-5.2* mg-1.8 urine: 07:55pm urine color-red appear-hazy sp -1.011 07:55pm urine blood-lg nitrite-neg protein-100 glucose-tr ketone-tr bilirub-neg urobiln-neg ph-5.5 leuks-neg 07:55pm urine rbc-35* wbc-25* bacteri-mod yeast-none epi-1 transe-<1 07:55pm urine casthy-5* 07:55pm urine amorphx-rare 07:55pm urine mucous-rare 07:55pm urine osmolal-346 07:55pm urine bnzodzp-neg barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg other pertinent labs: neuron specific enolase: pending at discharge heparin dependent ab: positive serotonin release assay: negative microbiology: blood culture, routine-pending-no growth to date blood culture, routine-pending-no growth to date blood culture, routine-final-negative sputum gram stain-final; respiratory culture-final-negative blood culture, routine-final-negative urine culture-final-negative stool clostridium difficile toxin a & b test-final-negative sputum gram stain-final-negative; respiratory culture-final {yeast} catheter tip-iv wound culture-final-negative blood culture, routine-final-negative blood culture, routine-final-negative urine culture-final-negative blood culture, routine-final-negative rapid respiratory viral screen & culture respiratory viral culture-final-negative; respiratory viral antigen screen-final-negative bronchoalveolar lavage gram stain-final-negative; respiratory culture-final {yeast}; legionella culture-final-negative sputum gram stain-final; respiratory culture-final {yeast} urine culture-final-negative blood culture, routine-final-negative blood culture, routine-final-negative sputum gram stain-final; respiratory culture-final {streptococcus pneumoniae}; legionella culture-final-negative legionella urinary antigen-final-negative blood culture, routine-final-negative urine culture-final-negative mrsa screen-final-negative blood culture, routine-final-negative blood culture, routine-final-negative blood culture, routine-final-negative studies: echo: very poor image quality. lv systolic function appears depressed. there is no ventricular septal defect. rv with depressed free wall contractility. the aortic valve is not well seen. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. cxr: 1. endotracheal tube in appropriate position. 2. nasogastric tube courses below the level of the diaphragm, inferior aspect not included on the image. 3. low lung volumes and possible mild pulmonary vascular congestion. 4. non-displaced fracture of the posterior right 8th rib. ct torso: left upper lobe aspiration or pneumonia. no pulmonary embolism upto the lobar and segmental branches. no abscess. diffusely hypodense liver with a enlarged portocaval lymph node but no splenomegaly. this is likely related to hepatitis. nchct: 1. evidence of diffuse cerebral edema without focal abnormality. 2. no acute intracranial hemorrhage. 3. likely right intra-ocular hemorrhage that may be secondary to reported history of "penetrating trauma" (according to a note on omr). echo: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 70%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve is not well seen. there is no aortic valve stenosis. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. no gross vegetations seen. impression: suboptimal image quality. no obvious vegetations. endocarditis cannot be excluded on the basis of this study. mri head: 1. acute ischemic foci in the bilateral globi pallidi as well as the left parietal and temporal lobe. given the involvement of the bilateral lentiform nuclei, an etiology of hypoxia should be considered. 2. no evidence of cerebral edema or hemorrhage. b/l lenis: no evidence of dvt in either lower extremity. b/l uenis: thrombus in the right cephalic vein. left cephalic vein not seen. no evidence of dvt otherwise noted. ct abd/pelvis: 1. small left groin hematoma without extension into the retroperitoneum or thigh. 2. stranding about several loops of small bowel in the right lower quadrant. this could reflect infectious or ischemic episode. less likely would be small hematoma. further evaluation if desired can be obtained by contrast-enhanced ct with oral contrast. femoral vascular ultrasound: small left groin hematoma with no pseudoaneurysm identified. left ueni: nonocclusive thrombus within the distal left cephalic vein. brief hospital course: 37 yo male with bipolar and history of polysubstance abuse found unresponsive, transferred from osh intubated s/p pea arrest and cpr on pressors. # cardiopulmonary arrest: as per report, the patient was estimated to have had approximately 45 minutes of down time in the field and at the osh with 5 pea arrests and one episode of ventricular tachycardia. on arrival, the patient was cooled, reaching target of 33 c at 8am . this was maintained for 24hrs and the patient paralyzed with cisatracurium. re-warming was complicated by patient being persistently febrile, so that excessively cooling from pads was causing skin changes. eventually pads were taken off at 4pm , after which patient was febrile to 101. by , patient opening eyes to voice and intermittently following commands. mri brain shows multiple small infarcts suggestive of hypoxia. he was extubated on and had complete neurologic recovery. the neurology team continued to follow him and did not find any subtle residual deficits from the small infarcts. # encephalopathy: most likely initially due to a drug overdose. his osh tox screen was positive for amphetamine, benzo, opiate, and etoh. he was also has severe leukocytosis on arrival, most likely result of cardiac arrest +/- infectious etiology. during the hospitalization, ms was also likely worsened by infection and sedating meds. he was initially treated with broad spectrum abx, then narrowed to treat strep pneumo (culture proven) pneumonia which was continued for an 8 day course. flagyl was given out of concern for aspiration pna. pt was given thiamine, folate and multivitamin as well. # septic shock. there was initial concerned for cardiogenic vs septic shock. he required pressors upon arrival, however these were discontinued after a few days as he began to recover. a tte showed normal cardiac function, ruling out a cardiogenic etiology. he was treated with antibiotics and fluid resuscitation with pressors and his condition improved. his blood pressures remained stable throughout the remainder of his hospital course. # respiratory failure. most likely hypoxic hypercarbic respiratory failure in the setting of od. intubated on arrival and extubated on day 8 of the admission with no further difficulty breathing. # anemia in setting of acute blood loss pt with dark aspirate from og tube and guaiac/gastroccult positive. ppi initiated. patient is to follow up with gi as an outpatient for possible egd. patient remained hemodynamically stable during this time period. following transfer out of the icu, the patient was noted to have a hematoma in his left groin (6x5cm). a ct scan did not show additional rp bleed and vascular ultrasound revealed normal blood flow through the vessel. # thrombocytopenia / possible hit concerned for hit with 4t score of 6 and cephalic vein clot, therefore heparin was held and pt was started on argatroban. heme was consulted and felt that his likely of hit was low, however anticoagulation should be given as long as it outweighed the bleeding risks pending the confirmatory serotonin release assay. sra was sent and was negative. the argatroban gtt was stopped and the patient was given fondaparinux for dvt ppx to avoid reintroducing unfractionated heparin. # superficial thrombophlebitis patient was noted to have an erythematous, warm region near his antecubital fossa on the left. it occasionally was noted to be weeping clear-whitish fluids. a nonocclusive clot was noted in the left cephalic vein. he was given approximately 48 hours of antibiotics, however given the overall appearance and history, it was decided that this was most likely due to superficial thrombophlebitis and was treated with hot packs and arm elevation. although not entirely, the region improved significantly prior to discharge. # acute renal failure / acute tubular necrosis: this was thought to be due to rhabdomyolysis and atn due to shock and poor renal perfusion. improved throughout the admission with supportive care only. his cr on discharge was 1.7. # diarrhea on the general medical floor, the patient c/o once daily bm consisting of loose liquidy stools. patient was noted to be cdiff negative and his volume status was closely monitored. # hyponatremia: associated with free water deficit. improved with free water repletion # transaminitis. most likely shock, lfts downtrending during the admission. upon discharge, only alt remains above the upper limit of normal. # rhabdomyolysis. the patient had no compartment syndrome on exam. likely from being altered and down for several hours. improved with fluid resuscitation. # hypertension: occurred after patient recovered from sepsis. hypertension was treated with clonidine given that there was also concern for withdrawal. home antihypertensives were slowly restarted as renal function improved. lisinopril continued to be held at discharge as cr remained elevated. ==================================== transitions of care ==================================== -dropping hematocrit with guaiac positive stools, patient is to see gi as an outpatient -pain regimen was altered to ms contin 30 mg q8h and roxicet. -lisinopril was held at discharge due to increased cr. pending labs: -neuro endolase -blood cultures x2 from medications on admission: - roxicet 5-325 mg, 1-2 tabs q6hr prn for pain - atropine 1% eye drop to the right eye 4 times daily - clonazepam 2 mg, 1 tab, - cyclobenzaprine 10 mg, tid prn - doxepin 150 mg qhs - hctx 25 mg daily - ibuprofen 800 mg tid prn - lisinopril 20 mg qd - morphine ms contin 60 mg tid for chronic pain - omeprazole 20 mg daily - prednisolone acetate 1 % ophthalmic suspension 1 drop to the right eye 4 times a day - simvastatin 20 mg qhs discharge medications: 1. morphine 30 mg tablet extended release sig: one (1) tablet extended release po q8h (every 8 hours). 2. prednisolone acetate 1 % drops, suspension sig: one (1) drop to right eye ophthalmic four times a day. 3. atropine 1 % drops sig: one (1) drop to right eye ophthalmic four times a day. 4. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 10. roxicet 5-325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 11. cyclobenzaprine 10 mg tablet sig: one (1) tablet po three times a day as needed for pain. 12. clonazepam 2 mg tablet sig: two (2) tablet po twice a day. 13. doxepin 150 mg capsule sig: one (1) capsule po at bedtime. discharge disposition: home with service facility: , discharge diagnosis: primary: pea arrest due to overdose, substance unknown. secondary: acute renal failure thrombocytopenia superficial thrombophelbitis hypertension pneumonia 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: mr. , it was a pleasure taking part in your care. you were transferred to our hospital after you were found to have overdosed on medications. you had a cardiopulmonary arrest that required cpr and mechanical intubation for breathing. you underwent a cooling protocol in the intensive care unit and required multiple medications for your blood pressure. you began to recover and were able to have the breathing tube removed and were transferred out of the icu. we found that you had developed a pneumonia for which you received antibiotics. we also noted that noticed your platelets had decreased and we were concerned that this was due to a reaction to a blood thinning medication known as heparin. you were started on a different blood thinning medication and more lab tests were sent. these lab tests were negative and the blood thinning medication was stopped. you also sustained a degree of kidney injury. this is improving, but it is not quite healed yet. it will be some time before we know if this is permanent. we also found that a hematoma had developed on the left side of your groin. this was likely due to a large iv that was used during your arrest. we did a ct scan which revealed that the bleed was isolated to this location and a ultrasound showed normal flow through the underlying vessel. we also noted that two small clots, one in both your left and right arm, had formed. these were likely due to smaller ivs that were used through out the course of your hospitalization. the clot on the left appears to have a mild infection. you do not need antibiotics for this unless it were to worsen. for now, this should be treated with warm packs and arm elevation. we found that your red blood cells, the cells that carry oxygen to your tissues decreased throughout the course of this hospitalization. we found that there is microscopic amounts of blood in your stool. this could be caused by many things and we recommended you follow up with a gastroenterologist. it is natural to feel weak after an arrest such as yours. you were evaluated by our physical therapist who feel you need additional, more intensive physical therapy at a rehabilitation center. you declined our offer and requested that you be discharged home. we recommend that someone be with you as often as possible while you are at home, ideally 24hrs a day. we strongly urge you to not use drugs in the future. please understand that this was actually a fatal overdose- you are very lucky to have been revived back to life. we are very happy that you were able to be resuscitated. another overdose might leave you with more permanent damage. please make the following changes to your medications: -hold: lisinopril as your kidney's recover until you doctor recommends otherwise. -please avoid taking ibuprofen/advil/motrin, as these medications can be damaging for your kidney and cause bleeding -please also avoid taking acetaminophen/tylenol, as this medication can be harmful to your liver. followup instructions: name: , j. location: family health/ internal medicine address: , , phone: when: monday, :00 am department: gastroenterology when: monday at 11:15 am with: , md building: lm campus: west best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances arterial catheterization arterial catheterization closed [endoscopic] biopsy of bronchus central venous catheter placement with guidance diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis unspecified essential hypertension acute posthemorrhagic anemia acute and subacute necrosis of liver unspecified septicemia hyposmolality and/or hyponatremia severe sepsis other, mixed, or unspecified drug abuse, unspecified poisoning by opium (alkaloids), unspecified poisoning by benzodiazepine-based tranquilizers accidental poisoning by other opiates and related narcotics accidental poisoning by benzodiazepine-based tranquilizers acute respiratory failure pneumonitis due to inhalation of food or vomitus cardiac arrest anoxic brain damage alkalosis septic shock cellulitis and abscess of upper arm and forearm cerebral edema other encephalopathy nontraumatic hematoma of soft tissue hemorrhage of gastrointestinal tract, unspecified phlebitis and thrombophlebitis of superficial veins of upper extremities cerebral artery occlusion, unspecified with cerebral infarction alcohol abuse, continuous rhabdomyolysis acute pancreatitis leukocytosis, unspecified heparin-induced thrombocytopenia (hit) toxic effect of ethyl alcohol unspecified causes of encephalitis, myelitis, and encephalomyelitis chronic ulcer of other specified sites personal history of methicillin resistant staphylococcus aureus accidental poisoning by psychostimulants pneumococcus infection in conditions classified elsewhere and of unspecified site acute venous embolism and thrombosis of superficial veins of upper extremity poisoning by amphetamines 

Answer: The patient is high likely exposed to