Physician's Assistant

Rapidreview Mon 20 October 2025 17:37

Last Modified: 24 weeks ago

MRN:

Content:

28-year-old male presented following intentional venlafaxine overdose (12 x 60mg tablets, non-sustained release formulation).

History of Presenting Complaint:
Patient reports intentional overdose with background of hearing voices. Previous psychiatry and ED assessments noted. Background of emotionally unstable personality disorder with recent deterioration according to psychiatry team. Patient states he feels bloated for the last few weeks and does not recall last time he opened his bowels. Reports lump on left lower abdomen.

Significant concern: Patient states if discharged home he will take a large number of tablets again if left alone. Reports having a stash of tablets at home including zopiclone which he will take if discharged home.

Social History:
Lives alone.

Medication History:
- Duloxetine 60mg PO OD
- Omeprazole 20mg PO OD 
- Quetiapine 300mg PO ON

Investigations:
- Coagulation screen: Normal
- Paracetamol level: <10
- U&Es: Normal
- LFTs: Normal
- CK: 150 (normal)
- Urea: 2 (normal)
- AST: Normal
- FBC: Unremarkable apart from mild neutrophilia 9.04
- Venous blood gas: Normal

Observations:
- Respiratory rate: 15
- Oxygen saturation: 97% on air
- Pulse: 119
- Blood pressure: 119/85
- Temperature: 37°C
- Blood glucose: Not yet checked

On Examination:
No palpable mass in abdomen despite patient reporting lump.

Toxicology advice: Patient has remained asymptomatic and not meeting criteria for concern. Recommended 6-hour observation period. No symptoms reported by nursing staff or patient.

Impression:
Medically stable following venlafaxine overdose

Plan:
1. 12-lead ECG
2. Recheck blood glucose
3. If ECG unremarkable and blood glucose normal, MFFD
4. Psychiatric team input - nursing staff to call psychiatry team to inform of planned discharge

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Summary:

Investigations:

Rapidreview Mon 20 October 2025 17:37

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