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: no known allergies / adverse drug reactions attending: chief complaint: tca overdose (likely flexeril) major surgical or invasive procedure: intubation central line placement history of present illness: this is a 45-year-old woman transferred to with ams and hypotension in the setting of an intentional ingestion. . per report, ms. was brought in by the police after her husband called 911 because she was expressing suicidal ideation. patient initially triaged at osh to psychiatry for evaluation, whereupon she developed altered mental status and hypotension. patient was intubated for airway protection with etomidate followed by succinylcholine and vecurunium. initial ekg revealed widenend qrs and rbbb widened so patient treated for presumed tca overdose. patient was placed on bicarb 2gm, magnesium 2gm, 2l ns and started on dopa drip. patient also received narcan 0.4 and decision made to transferred to for further evaluation. . at , ekg revealed qrs of 150: patient was given 1amp of bicarb and started on a bicarb drip. calcium was given as well. sbps remained in the 70s on max dopamine and decision was made to start levophed. repeat abg showed a ph 7.51 and bicarb gtt stopped. patient was then given intra-lipid 150ml iv x1 and 25ml/min x60minutes. toxicology was consulted and recommended continuing supportive care. . in the icu, ms. continued to improve. her qrs narrowed and the bicarb drip was stopped. she was extubated and called out to the floor. patient told micu team that she may have taken old migraine medication, which likely had tca-like properties. past medical history: depression with previous suicide attempt migraines with aura asthma oa social history: patient is currently unemployed. she lives with a roommate and is estranged from her husband. a history of domestic and sexual abuse. has a 22-year-old daughter, 3-year-old grandson, and daughter is expecting. family history: noncontributory physical exam: on admission: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema on discharge: vitals stable general: no acute distress, flat affect, pleasant heent: moist mucous membranes neck: no cervial, submandibular, or supraclavicular lad chest: cta bilaterally, no wheezes, rales, or rhonchi cardiac: rrr, no murmurs, rubs, or gallops abdomen: +bs, soft, non-tender, non-distended extremities: no edema bilaterally skin: warm, slightly diaphoretic psych: slightly aloof affect, conversant, tearful but smiling appropriately pertinent results: admission labs: 11:46pm type-art rates-18/ tidal vol-500 peep-5 o2-50 po2-180* pco2-36 ph-7.55* total co2-32* base xs-9 -assist/con intubated-intubated 10:20pm type- temp-36.9 rates-18/ tidal vol-500 peep-5 o2-50 po2-43* pco2-42 ph-7.50* total co2-34* base xs-7 intubated-intubated vent-controlled 10:20pm glucose-130* lactate-2.1* na+-136 k+-3.2* cl--98 10:20pm hgb-10.6* calchct-32 10:20pm freeca-1.02* 04:26pm type- po2-153* pco2-43 ph-7.48* total co2-33* base xs-8 comments-green top 04:26pm lactate-3.1* 04:00pm glucose-172* urea n-11 creat-0.8 sodium-139 potassium-3.5 chloride-101 total co2-30 anion gap-12 04:00pm calcium-8.2* phosphate-1.4* magnesium-2.0 11:26am po2-45* pco2-45 ph-7.45 total co2-32* base xs-6 11:26am lactate-3.6* 11:12am glucose-147* urea n-15 creat-0.9 sodium-138 potassium-3.0* chloride-97 total co2-28 anion gap-16 11:12am alt(sgpt)-20 ast(sgot)-31 alk phos-66 tot bili-0.1 11:12am calcium-8.6 phosphate-1.1* magnesium-2.1 11:12am wbc-12.2* rbc-3.49* hgb-11.1* hct-29* mcv-83.5 mch-31.7 mchc-38.2* rdw-12.5 11:12am plt count-350 07:54am type- po2-82* pco2-51* ph-7.36 total co2-30 base xs-1 comments-green top 07:54am lactate-4.5* 04:47am type-art temp-37.0 po2-246* pco2-47* ph-7.51* total co2-39* base xs-13 04:40am glucose-326* urea n-19 creat-1.1 sodium-139 potassium-4.6 chloride-102 total co2-18* anion gap-24* 04:40am estgfr-using this 04:40am alt(sgpt)-24 ast(sgot)-36 ld(ldh)-392* alk phos-69 tot bili-0.4 04:40am lipase-90* 04:40am albumin-4.2 calcium-7.8* phosphate-1.6* 04:40am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-pos 04:40am glucose-294* lactate-2.5* na+-139 k+-3.9 cl--99 tco2-25 04:40am wbc-14.2* rbc-3.98* hgb-12.2 hct-33.7* mcv-85 mch-30.6 mchc-36.1* rdw-12.6 04:40am pt-10.8 ptt-18.4* inr(pt)-0.9 04:40am pt-10.8 ptt-18.4* inr(pt)-0.9 04:40am fibrinoge-197 . ekg : sinus rhythm at the upper limits of normal rate. rightward axis. consider right bundle-branch block. borderline prolonged q-t interval. no previous tracing available for comparison. clinical correlation is suggested. qrs 154 . cxr : the right internal jugular line is malpositioned with the tip coursing towards the right axilla, probably within the right subclavian vein. however an inadverant position into the arterial system cannot be ruled out. consider repositioning the catheter. bilateral lung volumes are low. right lower paracardiac opacity, left lower lung and retrocardiac opacities are likely from lung atelectasis. . cxr : lines and tubes remain in place in a standard position. there are persistent low lung volumes. there is no pneumothorax/pleural effusion. there are persistent bibasilar opacities likely atelectasis. perihilar opacity and the left suprahilar region is also unchanged. attention in followup in this area is recommended. this could be due to atelectasis, but an underlying lung lesion can be present. . cxr : as compared to the previous radiograph, the patient has been extubated. all other monitoring and support devices have also been removed. arising from the middle portions of the left hilus is a band-like opacity that is directed towards the left lung apex. the appearance of this opacity is resembling atelectasis. at the bases of both the right and the left lungs, a subtle parenchymal scarring is seen. resolution of the atelectasis should be monitored with chest x-ray. in case of non-resolution, a ct should be performed. normal size of the cardiac silhouette. no pleural effusions. status post right shoulder surgery. . white blood cells 5.0 4.0 - 11.0 k/ul performed at west stat lab red blood cells 3.55* 4.2 - 5.4 m/ul performed at west stat lab hemoglobin 10.7* 12.0 - 16.0 g/dl performed at west stat lab hematocrit 30.5* 36 - 48 % performed at west stat lab mcv 86 82 - 98 fl performed at west stat lab mch 30.2 27 - 32 pg performed at west stat lab mchc 35.1* 31 - 35 % performed at west stat lab rdw 12.9 10.5 - 15.5 % glucose 83 70 - 100 mg/dl if fasting, 70-100 normal, >125 provisional diabetes performed at west stat lab urea nitrogen 11 6 - 20 mg/dl performed at west stat lab creatinine 1.1 0.4 - 1.1 mg/dl performed at west stat lab sodium 141 133 - 145 meq/l performed at west stat lab potassium 4.1 3.3 - 5.1 meq/l performed at west stat lab chloride 108 96 - 108 meq/l performed at west stat lab bicarbonate 24 22 - 32 meq/l performed at west stat lab anion gap 13 8 - 20 meq/l chemistry calcium, total 8.7 8.4 - 10.3 mg/dl performed at west stat lab phosphate 3.9 2.7 - 4.5 mg/dl performed at west stat lab magnesium 2.3 1.6 - 2.6 mg/dl performed at west stat lab glucose 147* 70 - 100 mg/dl if fasting, 70-100 normal, >125 provisional diabetes performed at west stat lab urea nitrogen 15 6 - 20 mg/dl performed at west stat lab creatinine 0.9 0.4 - 1.1 mg/dl performed at west stat lab sodium 138 133 - 145 meq/l verified by alternate methodology performed at west stat lab potassium 3.0* 3.3 - 5.1 meq/l verified by alternate methodology performed at west stat lab chloride 97 96 - 108 meq/l verified by alternate methodology performed at west stat lab bicarbonate 28 22 - 32 meq/l performed at west stat lab anion gap 16 8 - 20 meq/l enzymes & bilirubin alanine aminotransferase (alt) 20 0 - 40 iu/l hemolysis falsely elevates alt performed at west stat lab asparate aminotransferase (ast) 31 0 - 40 iu/l hemolysis falsely elevates ast. performed at west stat lab alkaline phosphatase 66 35 - 105 iu/l performed at west stat lab bilirubin, total 0.1 0 - 1.5 mg/dl performed at west stat lab chemistry calcium, total 8.6 8.4 - 10.3 mg/dl performed at west stat lab phosphate 1.1* 2.7 - 4.5 mg/dl performed at west stat lab magnesium 2.1 1.6 - 2.6 mg/dl performed at west stat lab brief hospital course: ms. is a 44-year-old woman with a pmhx. significant for depression and previous suicide attempts who presents with intentional ingestion, likely from tca-like substance. . # overdose: patient presented with suicidality/intentional overdose to osh and soon developed hypotension with obtundation necessitating intubation for airway protection. she was started on dopamine and transferred to where initial toxicology screen tested positive for serum tcas. she had qrs prolongation to 150s on transfer consisitent with sodium channel blockade. toxicology team was consulted and followed closely. she received bicarb and intralipid in the ed. she was started on a sodium bicarbonate drip in the icu over the course of about 24 hours with steady narrowing of her qrs interval, which closed to a normal 116 by later her first hospital day and remained narrow after discontinuing her bicarb drip on hd2. she was extubated on hd2. upon waking, she struggled to recall the name of the culprit medication. she did recall an old migraine medication that sounded like it could have tca component. of her listed meds, both flexeril and seroquel can cause a false tca serum test, and the former is structurally similar to tcas. she met with the psychiatry team, and noted that she recently separated from her husband, though has frequent contact with him. she found him with a new partner the night of the overdose, which prompted her decompensation. . # depression: as above, she is depressed with active suicidality prompted by a negative interaction with her ex-husband and his partner. a section 12 was placed in the patient's chart, and she had a 1:1 sitter throughout admission. most of ms. psychiatric medications were stopped except for her citalopram. these medications can be restarted at the discretion of her psychiatry team. . # left upper arm swelling: on the day of discharge from the medical floor, ms. was noted to have a swollen, indurated left upper arm. an ultrasound (wet-read) showed: "basilic vein superficial thrombophlebitis just above the antecubital fossa on the left (at the site of the patients skin changes). no dvt." she was instructed to continue using warm packs on the arm and keep it elevated. . # abnormal cxr: patient had a cxr on while she was intubated that was concerning for atelectasis vs. mass. although the image is most consistent with atelectasis, radiology suggested that ms. have a repeat cxr in the next 2-4 weeks, and then ct scan if cxr continues to be abnormal. . # asthma: fluticasone and albuterol were continued. . # anemia: mild anemia during this admission, fluid resuscitation likely caused a dilutional effect. hct 30 on discharge. can be followed after discharge. medications on admission: citalopram 40mg 1.5 tabs qd vitamin 1cap weekly fluticasone 110 mcg inh gabapentin 300mg 1 tab hydroxyzine 50mg cape 1cap qhs pantoprazole 40mg tab qd seroquel xr 150mg tab qd traimterene/hctz 37.5/25 2 caps qd fioricet 1tab q8hrs prn headache albuteral inh 2puffs q4hrs\flexeril 10mg 1 tab q4hr benadryl 25mg cap 1 prn itch naproxen 500mg tab 1 tab oxazepam 10mg tab zolmitriptan 5mg oxycodone 5mg tab q6hrs as needed for pain (20tabs) flexeril 10mg 0.5-1mg tid pravochol 40mg qd mvi discharge medications: 1. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: two (2) capsule po once a day. 6. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: tablets po every eight (8) hours as needed for headache. 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 8. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 9. gabapentin 300 mg capsule sig: one (1) capsule po twice a day. discharge disposition: extended care discharge diagnosis: overdose (likely from tca-like substance) respiratory compromise hypotension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you during this admission. you came to the hospital because of a drug overdose. you were intubated and on vasopressors (to keep your blood pressure up), and we carefully monitored your ekgs. your condition stablized, and we were able to take you off the breathing machine. your ekgs have been normal since that time. we all agree that you need further psychological treatment, and that would be best attained at an inpatient psychiatric unit. . a chest xray on was normal except for a patchy area that needs to be further evaluated in order to rule out a mass. the radiologists recommended getting a repeat chest xray in weeks (in early ), and if the concerning area is still there, go for a ct scan of your chest. . your left arm was swollen, likely because of an infiltrated iv. we did an ultrasound that was negative for a deep blood clot. . we started a medication called fioricet for your headaches. . the following changes were made to your medications: please stop taking: hydroxyzine, seroquel, benadryl, naproxen, oxazepam, zolmitriptan, and oxycodone until intstructed by your outpatient providers. followup instructions: you will need to see your primary care physician after you are discharged from the psychiatric facility. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: anemia, unspecified asthma, unspecified type, unspecified acute respiratory failure hypotension, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of superficial veins of upper extremities migraine, unspecified, without mention of intractable migraine without mention of status migrainosus suicide and self-inflicted poisoning by other specified drugs and medicinal substances suicidal ideation poisoning by skeletal muscle relaxants 

Answer: The patient is high likely exposed to