CASE 29: OVERDOSE?
History
A 30-year-old woman is brought up to the emergency department at 2 pm by her hus-
band. He is worried that she has taken some tablets in an attempt to harm herself. She has
a history suggestive of depression since the birth of her son 3 months earlier. She has been
having some counselling since that time but has not been on any medication. The previ-
ous evening about 10 pm she told her husband that she was going to take some pills and
locked herself in the bathroom. Two hours later he persuaded her to come out and she said
that she had not taken anything. They went to bed but he has brought her up now because
she has complained of a little nausea and he is worried that she might have taken something
when she was in the bathroom. The only tablets in the house were aspirin, paracetamol and
temazepam which he takes occasionally for insomnia.
She complains of a little nausea although she has not vomited. She has had a little abdom-
inal discomfort. There is no relevant previous medical or family history of note. She
worked as a social worker until 30 weeks of the pregnancy.
Examination
On examination she is mentally alert. She says that she feels sad. Her pulse is 76/min,
blood pressure is 124/78 mmHg and respiratory rate is 16/min. There is some mild abdom-
inal tenderness in the upper abdomen but nothing else abnormal to find.
NormalHaemoglobin 12.7 g/dL 11.7–15.7 g/dL
Mean corpuscular volume (MCV) 87 fL 80–99 fL
White cell count 6.8% 109 /L 3.5–11.0% 109 /L
Platelets 230 % 109 /L 150–440% 109 /L
Prothrombin time 18 s 10–14 s
Sodium 139 mmol/L 135–145 mmol/L
Potassium 3.8 mmol/L 3.5–5.0 mmol/L
Urea 4.6 mmol/L 2.5–6.7 mmol/L
Creatinine 81 &mol/L 70–120&mol/L
Alkaline phosphatase 88 IU/L 30–300 IU/L
Alanine aminotransferase (AAT) 37 IU/L 5–35 IU/L
Gamma-glutamyl transpeptidase 32 IU/L 11–51 IU/L
Glucose 5.1 mmol/L 4.0–6.0 mmol/LINVESTIGATIONS
Question
- What should the management be now?