Transcription - 20251020T 18-20.mp3

Luke rundle 1 363135 5 28 year old man presented complaint intentional venlafaxine overdose 12 times 60 mg of not sustained release venlafaxine history presenting complaint intentional overdose reports hearing voices notes psychiatry and ed assessments with thanks background of by of emotionally unstable personality disorder and seems to have been deteriorating for a little while according to psychiatry team social history lives alone medication history duloxetine 60 mg tablets omeprazole 20 mg once decortiapine 300 mg once at night investigations coagulation screen normal paracetamol level less than 10 euzenies normal lfts normal ck 150 open brackets normal urea 2 ast normal full blood count unremarkable apart from mild neutrophilia 9.04 venous blood gas normal note tox based advice if have remained asymptomatic not meeting above criteria should be observed for 6 hours no mention of symptoms from nursing staff or patient observations respiratory rate 15 oxygen saturation 97% on air pulse a 119 blood pressure a 119 over 85 temperature 37 blood glucose not checked plan 12 lead ecg number 2 recheck blood glucose number 3 if ecg unremarkable and blood glucose normal could go home note psychiatric team input nursing staff to kindly call them to let them know the patient is being discharged impression stable following venlafaxine overdose number 1 12 number 2 blood glucose monitoring number 3 psychiatric review given desire to take additional tablets number 4 if above normal then medically stable for discharge history of presenting complaint states feels bloated and has done for the last few weeks full stop does not recall last time he opened his bowels full stop <\n\n> Reports lump on the left lower abdomen on examination no palpable mass here asking for dazepam however I can't see this on his gp record full stop <\n\n> Reports that if he goes home he will take a large number of tablets again if he's left alone in a room he says he has a stash of tablets at home including zopiclone which he'll take if he is left home full stop

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

Summary

Investigations

Plans