Overdose and risk assessment

Question 1

Paracetamol overdose:

a) Patients more at risk of harm in overdose
b) Presentation - first 24h? Then…?
c) Possible metabolic complications
d) Signs o/e (of acute hepatic failure)

Answer 1

a) Those taking P450 inducers (e.g. rifampicin, phenobarbital, phenytoin, carbamazepine and ALCOHOL)
Also, those with depleted glutathione reserves (HIV, malnutrition, liver disease)
b) Initially asymptomatic/ nausea and vomiting. After 24h, hepatic necrosis causes RUQ pain and jaundice with very raised ALT (> 1000)
c) Clotting abnormalities (raised PT), Encephalopathy.
Oliguria. Hypoglycaemia, Renal failure, Lactic acidosis
d) Signs: jaundice, liver flap, tender hepatomegaly

Question 2

Paracetamol overdose: assessment

a) Assessing suicidal intent
b) Other risk factor
c) Bloods
d) Treatment is based on…?

Answer 2

a) Isolation, Timing, Precautions, Action, Final acts, Suicide note, Lethality, Stated intent, Premeditated, Reaction, Predictable outcome, Death without treatment
b) Alcohol intake
c) Paracetamol levels (4h post-ingestion), UEs and creatinine, LFTs, glucose, clotting (PT)
d) If they are at or above the treatment line on the nomogram

Question 3

Paracetamol overdose: management

a) If treatment indicated - drug and route? (MoA?)
b) NAC is effective if given within…?
c) Continue treatment for how long?
d) General management of acute poisoning
e) Before discharge - bloods to check
f) Referral to…?

Answer 3

a) NAC (IV infusion) - precursor to glutathione
b) 8 hours
c) Usually 24h
d) A-E, refer to Toxbase if necessary, activated charcoal, gastric emptying, whole bowel irrigation, haemodialysis, forced diuresis, supportive Rx
e) INR, renal function and LFTs
f) Psychiatry (MHA if necessary), and ICU if severe liver or renal failure

Question 4

Biopsychosocial formulation post-suicide attempt

Answer 4

• Bio: Untreated mental health disorders. Physical symptoms and disorders.
• Psycho: Suicidal intent, Coping strategies.
  Skills, strengths and assets. Psychosocial and occupational functioning.
• Social: Social problems. Personal and financial difficulties. Needs of dependants (protective factors)

Question 5

Management post-suicide: CRISIS

Answer 5

Crisis team involved/ crisis plan
Risk assessment - modify risk factors
Intent to self harm evaluated
Support 24/7
Interventions
Section if necessary

Question 6

MHA.

• section 2: fulfil what three criteria
• section 3: also…?

Answer 6

S2.

• Mental health condition
• Of a nature or degree severe enough to warrant detention
• Risk to themselves, to others or to their health

S3.
- Also available treatment