Toxicology Note

Clinical Toxicology Unit Review Age and Sex: 32-year-old female PRESENTING COMPLAINT: The patient presented with confusion and drowsiness following an overdose of medication. She reported nausea and abdominal pain. RISK ASSESSMENT Time of ingestion: Approximately 3 hours prior to arrival Drug and dose: Paracetamol, 20 tablets of 500mg each Decontamination: The patient has vomited twice since the overdose History: The patient has a history of depression and anxiety, for which she is on medication. No significant surgical history. No previous overdoses. Medications: Sertraline 50mg daily Allergies: No known drug allergies Substances: Occasional alcohol consumption, no illicit drug use, non-smoker Social history: The patient is a teacher and lives alone. She has been experiencing increased stress at work. CLINICAL FEATURES Mental state examination: The patient is drowsy but responsive to verbal stimuli. Oriented to person but not to time or place. General state of health: Appears pale and lethargic WORLD backwards: Unable to perform Physical examination: Mild epigastric tenderness, no guarding or rebound tenderness Mobilisation: The patient has not mobilised since the overdose Urination: The patient has not passed urine since the overdose Observations Vital signs: BP 110/70 mmHg, HR 90 bpm, RR 18/min, Temp 36.8°C, SpO2 98% on room air Investigations Serum paracetamol level: 150 mg/L MANAGEMENT Supportive cares: The patient received intravenous fluids and N-acetylcysteine as an antidote IMPRESSION Likely diagnosis: Paracetamol overdose Differential diagnosis: None PLAN Investigations planned: Repeat serum paracetamol level in 4 hours Treatment planned: Continue N-acetylcysteine infusion Relevant other actions: Referral to psychiatric services for further assessment and counselling