What happens in A&E when taken overdose *TRIGGER ALERT*

[NotExactlyHappyToHelp]

Someone very close to me (being deliberately vague sorry) has taken a paracetamol overdose and been taken to A&E.

Because of COVID no ones allowed to go with them which is understandable.

We know they’re waiting on blood test results and if they’re ok then talk to the mental health team if not then further treatment I guess?

Could anyone tell me what might happen next?

I’m sat here on edge not knowing whether they might be discharged this evening or if they’ll keep them in.

I know these things vary between regions and stuff so I’m not looking for a solid answer just maybe a vague guide?

Sorry I’m not much help here, but everything crossed for you that they’re ok.

@littlefireseverywhere Thank you that’s very kind of you.

First of all they will assess the blood test results to see if the person is in physical danger from the amount they took. They will likely keep them in for monitoring for a few hours and send a mental health team to speak to them and discuss a care plan. If the overdose has not caused any physical complications they will likely discharge them the same day. In my experience they don’t tend to admit people unless it’s an absolute last resort but this obviously depends on the safety of the person, the amount taken and their history. Hope that helps a bit.

I once has reason to sit with someone who had accidentally OD’d on booze and Valium.

She was given a drug to induce vomiting and then put on a saline drip and monitored for around 8 hours. Bloods etc were taken and then she was released with no follow up.

Hope your loved one is ok.

Someone close to me does it regularly. It has varied from putting her on a drip to reverse the effects and then Discharge to sectioning her.

I would imagine if it's the first time they would probably be released maybe with follow up from local mental heath team although they are very stretched at the moment I think.

Thank you both that’s very helpful.

They were given activated charcoal by the paramedics.

I didn’t think they’d be kept overnight but the police told us they’d probably keep them in which surprised me.

I’m just a big ball of nerves now waiting to hear something.

It is very dependent on the area you're in, which consultants are on duty etc, the patient history. If they feel they are in need of a psych assessment they make keep them in until tomorrow

Depending on amount taken (doesn’t need to be much) they may well have to give a drip to counteract the paracetamol. Paracetamol can impact the liver so the drip is needed and is often administered for 24 hours. I can’t recall the name of the medication.

They will likely need to see psych liason who will talk to them and as others have said assess what’s going on. Ultimately the outcome could be anything from discharge with limited to no support to being sectioned.

I hope you are okay.

In terms of the paracetamol as they've already taken the charcoal not much more will happen. They might give fluids to help flush kidneys etc out if the bloods show up any signs of distress but otherwise, not much more they can do. There will be a referral to mental health team the outcome of which cannot be second guessed. As there was police involvement i wouldnt be surprised if they are kept overnight for observations but then they could be discharged with just gp intervention or they could be sectioned, or any host of measures in between.

They will have their blood taken 4 hours after the initial paracetamol od. If they've taken them over several hours rather than all in one go they will automatically start the treatment as the blood test isn't accurate. If the blood test is high they start an intravenous treatment to protect their liver. They stay (usually overnight) and see a mental health professional to decide if they need ongoing support.

I'm an A&E Nurse, not sure if what the Hospital I work at is what all hospitals do - but for us.

Blood tests - check the paracetamol level in the blood post overdose and subsequent Charcoal.

If the paracetamol level is still high enough to require treatment then treatment is given (Acytlcystine) - a full course usually takes 24 hours. Followed by further blood tests to see if this has corrected any damage. If not - give it again and keep trying.

Seen by our crisis team (when ever deemed medically fit.) They will either discharge home if they feel it's safe, or refer on for a formal Mental Health Act Assessment. This can take many hours if they do need an MHA because independant psychiatric doctors have to be found :) they will either discharge home, or arrange a voluntary admission to a mental health unit, or arrange for the patient to be sectioned.

I'm really sorry you're dealing with this, and hope that both you and your friend come out OK :) x

@YellowandGreenToBeSeen They never give anything nowadays to induce vomiting, especially with alcohol as there is a major risk of aspirating and inhaling vomit into the lungs. Valium and alcohol would just be monitored, as unlikely to kill you.

@ShopTattsyrup Me too.....we've seen far too many overdoses. So sad.

Sorry your loved one has been under pressure

In hospital They’ll medically stabilise and take bloods for assessment purpose eg liver function, kidney function . Kidneys and liver are at risk
Put on a drip and monitor vital signs

If required Treatment with N-acetylcysteine administered in IV drip

Psych liaison if mental health is a mitigating factor. Psych liaison will screen and assess. If mental health is a factor may be recommendations for admission either formal or informal

Follow up visit with home treatment team
Dc letter to inform GP

I knew someone who took a very small overdose (still not good obviously!) And was kept in overnight and discharged home the next day.

• of paracetamol

Pressed too soon
Follow up with home treatment/crisis team if psych liaison recommend it after their assessment

[quote puzzledpiece]@YellowandGreenToBeSeen They never give anything nowadays to induce vomiting, especially with alcohol as there is a major risk of aspirating and inhaling vomit into the lungs. Valium and alcohol would just be monitored, as unlikely to kill you.

[/quote]
This was about 8 years ago so I appreciate treatment may have changed.

Thank you everyone for the good thoughts and the experiences of how it’s dealt with.

@puzzledpiece thank you the 4 hours thing makes sense now. I wondered why they were waiting until a specific time to do bloods.

I’m staying up and dressed fuelled on coffee in case they need fetching.

Treated like you’re wasting their precious time in my experience. I was given a bed but no blanket and had a cannula put into my arm so hard that when it was taken out, it was bent nearly 90*.

Your loved one will need a lot of support of over the next few weeks. Their emotions will run very high and low. Look after them and yourself.

It depends on the patient’s history too. My friend’s sister (unfortunately) regularly takes paracetamol overdoses, they almost always admit her due to her history as she’s previous been under mental heath care

In my experience nothing much will happen.
My son has tried overdosing 3 times. He is 20. Each time he saw a crisis team and was released. His last attempt was 8 days ago and he's had 3 visits from the crisis team and they discharged him yesterday with no new support or help.

Sounds like a lot had changed in 30 years.

I got blue-lighted to the infirmary, where I had my stomach pumped.

Fun times.

They’re being admitted due to their liver function. I guess this means I can go to bed and not sleep.

@TheDoctorDances I’m so sorry that happened to you. My heart breaks to think someone would treat a person who’s so vulnerable like that. I desperately wish I could be with my person to advocate for them and keep an eye on how they’re treated.

@Bonkerz I’m so sorry that must be so hard for you both. I got the feeling that if medically they were ok my person would’ve been discharged by now.

They won't release till seen someone from crisis team which can be a very long wait. My son went in at 2am and was finally released at 4pm the next day. He was medically 'fit' by 11am.