Self-harm and suicide-ILA

Question 1

What investigations do you do for a paracetamol OD?

Answer 1

Paracetamol levels- over 1000mg/kg shows hepatotoxicity- if staggered OD then can’t properly interpret

ALT >1000 be concerned and all LFTs

U+Es for kidney function

Salicylate levels

Clotting- prothrombin and INR

ABG for acidosis

Urinary drugs

Alcohol levels

Question 2

What are risk factors for suicide?

Answer 2

Male, aged 19-34, divorce/widow/single, unemployed/retired, low socioeconomic background, live alone, psychiatric illness, alcohol use, previous attempts, family history, bereavement

Question 3

What is the pathophysiology of paracetamol OD?

Answer 3

Peak plasma concentration occurs after one hour

Toxic metabolite is formed in liver and kidney causing necrosis

Increased induction when used with alcohol, rifampicin or carbamazepine

Question 4

What physical symptoms would you ask about with a paracteamol OD?

Answer 4

N+V, encephalopathy, oliguria, renal failure and lactic acidosis

Question 5

What is the management for a paracetamol OD?

Answer 5

N- acetylcysteine

Crisis team if think could manage partly at home eg don’t live alone

sectioning

Question 6

What do you ask about after a suicide attempt?

Answer 6

Did she plan this? Triggers? Did she take any precautions not to be found? Did she seek help? Number of tablets? Time taken? Note left? Affairs in order? Alcohol involved? How does she feel now and does she regret it? Done this before? Guilt? Hopelessness? Protective factors?