material used during final exam preparation hope benefit for all *at own risk

1. A 35-year-old obese woman with a history of depression and previous self-harm
comes to the ED after an unwitnessed overdose. She claims to have taken 30
tablets of paracetamol four hours previously, along with a bottle of wine. She has a
history of chronic alcohol use and takes no regular medications.
Q1: What are the presenting features of PCM poisoning?
Q2: How would you manage this patient?
Patentname:wwf
Age:35
Address:ShahAlam
Occupation:Businesswoman
CC
Vomitingaftertaking30 oral tablets.
HOPI
Patientisknowncase of depression andself-harmtendency.Havingvomitingaftertook30 tabletsof
paracetamol 4 hours ago (9pm) at home.She alsodrinksa bottle of wine.She tookbothsubstances
to feel calmand try to sleep despiteknowingitisharmful toher.She vomited5times,the vomitus
contentare foodparticle.Nobloodstained.Notassociatedwithabdominal pain.
PASTMEDICAL HISTORY
DiagnosedwithMajordepressivedisordersince 5years – not compliance of medication
Chronicalcoholismonrehabilitationsince 2years
 Usuallydrank2-3 bottle of alcohol (beer) everyday
 She feel thatalcohol helphertofeel betteranddoesn’tfeel guiltyandcuttingdownthe
amount
 Drinksinthe morningtohelpwithhangover
 Joinedalcohol anonymousbutdoesn’thelphertobecome better
No chronicillnesslike diabetesmellitusandhypertension
No otherpsychiatricillness

2. PASTSURGERY HISTORY
No significanthistory
FAMILY HISTORY
No significanthistory
No otherpsychiatricillnessormedical illnessrunsinthe family
SOCIALHISTORY
Nota smoker
No othersubstance abuse
Single
Live withmother(65 yearold)
ABCDE
A: Secure airway:patentandclear
B: maintainoxygenonroomair: SpO2>94%
C: 2 large bore IV cannular: drawbloodforinvestigation

3. PHYSICALEXAMINATION
General appearance
 Patientsislyingonbed,seemlethargic.Conscioustotime,place andperson
 Signof dehydration –drymouth, coatedtongue
 Healedscar at the rightwrist
Vital
 BloodP – 110 / 70
 Pulse rate
 Respiratoryrate
 temperature
Systemicexamination
 All systemare normal
INVESTIGATION
Full bloodcount
Serumacetominophne
Serumelectrolyte
Bloodglucose
Creatinine
Liverfunctiontest – serumtransaminase,bilirubin,protrombintime(INR)
Renal functiontest - BUN
ECG

4. Q1: What are the presenting features of PCM poisoning?

5. Q2: How would you manage this patient?