Physician's Assistant

Refined clerking Tue 21 October 2025 11:25

Last Modified: 167 days ago

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Content:

Medical ST5 Miller Clerking

Presenting Complaint:
Deliberate self harm and paracetamol overdose

History of Presenting Complaint:
Presented following deliberate self harm and staggered paracetamol overdose. On 19/10/25 at 9pm, took 6 co-codamol 500/8mg tablets with suicidal intent. On 20/10/25 at 9pm, took 16 co-codamol 500/8mg tablets with suicidal intent. Also consumed 1 bottle of cider and used a clean new blade to make multiple superficial lacerations to left arm. Lacerations were assessed by ED team and did not require closure. Patient reports no current symptoms of paracetamol toxicity. This is in the context of previous self harm episodes in August 2025.

Past Medical History:
• Iron deficiency anaemia (September 2025)
• Self harm (August 2025)
• Mixed anxiety and depression (February 2025)
• Attention deficit hyperactivity disorder (2024)
• POTS and hypermobility (2023)
• Autistic spectrum disorder (2016)
• Previous deliberate self harm

Drug History:
• Sertraline 100mg PO OD

Allergy History:
Not documented

Social History:
Not documented

On Examination:
General Appearance: Patient declined examination
Observations: HR 67, BP 129/88, Temp 36.7°C, RR 17, O2 sats 98% on air

Investigations:
• Paracetamol level: 103 (time not specified)
• CK: 54
• Urea: 2.5
• AST: Normal
• INR: 1.1
• Hb: 118 (previously 121)
• Mild monocytosis noted
• LFTs: Normal
• Ferritin (10/09/25): 16 micrograms/L confirming iron deficiency anaemia

Impression:
Staggered paracetamol overdose with deliberate self harm in context of known mental health conditions

Management Plan:
1. NAC infusion commenced for paracetamol overdose
2. Blood tests in 4 hours: FBC, U&Es, LFTs, AST, INR, VBG
3. If bloods reassuring, discharge at end of second NAC infusion
4. Mental health team review - patient states already seen
5. GP follow-up arranged - patient spoke to GP this morning
6. Nursing staff to confirm psychiatric assessment completed

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Investigations:

Refined clerking Tue 21 October 2025 11:25

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