Amka Oxendine is a 19-year-old female college student presenting with abdominal pain and nausea following an acetaminophen overdose with suicidal intent, triggered by a recent breakup with her boyfriend. In this comprehensive guide, we’ll walk you through how to approach her case, from initial mental health assessment through toxicology management to the final diagnosis of acute acetaminophen ingestion with major depressive disorder. You’ll learn the key clinical reasoning steps, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this mental health and toxicology case simulation.
Only a few hours left for your iHuman case study?
Send us the brief, and we’ll deliver it fast
Amka Oxendine iHuman Case Overview (Doorway Information)
Patient Overview: Amka Oxendine is a 19-year-old female college student who was brought to the emergency department by Emergency Medical Services (EMS) following a suicide attempt by ingesting 15 extra-strength acetaminophen pills. She presents with chief complaints of abdominal pain and nausea. This suicide attempt was triggered by a breakup with her boyfriend and she reports having a difficult time since joining college.
Key Background Information:
- Age/Gender: 19-year-old female
- Chief Complaint: Abdominal pain and nausea following acetaminophen overdose
- Duration: Four hours post-ingestion before calling EMS
- Circumstances: Suicide attempt triggered by recent breakup with boyfriend
- Associated Symptoms: Nausea, abdominal discomfort
- Significant History: History of depression and previous suicide attempt at age 15
- Current Medications: None reported
- Academic Status: College freshman struggling academically
- Psychosocial Stressors: Few friends, feelings of loneliness, failing classes, recent relationship breakup
The patient appears alert and oriented on presentation, with vital signs within normal limits. Her presentation requires immediate assessment for acetaminophen toxicity and comprehensive mental health evaluation, making this an excellent case for learning systematic toxicology assessment and suicide risk evaluation skills.
Amka Oxendine (19 y/o female) – Mental Health & Toxicology Assessment
- CC: Abdominal pain and nausea post-acetaminophen overdose
- MSAP: Acute acetaminophen ingestion with suicidal intent
- Mental Health Concerns: Depression, suicidal ideation, recent psychosocial stressors
- History: Previous suicide attempt, academic struggles, social isolation
- Triggering Event: Recent breakup with boyfriend
History Questions:
- How can I help you today?
- Can you tell me what happened that brought you here?
- What did you take and how many pills?
- What time did you take the medication?
- What was going through your mind when you took the pills?
- Have you had thoughts of hurting yourself before?
- Do you have any allergies to medications?
- Are you currently taking any medications?
- Have you used alcohol or other substances in the past 24 hours?
- Tell me about your mood lately
- How have things been going at school?
- Do you have support from family or friends?
- Have you been sleeping and eating normally?
- Have you had any nausea, vomiting, or abdominal pain?
- Do you have any medical problems or past hospitalizations?
- Have you received mental health treatment before?
- Are you having thoughts of hurting yourself now?
- Do you feel safe going home?
Physical Exam:
- Vitals: pulse, BP, respirations, temperature, O2 saturation
- General appearance: level of consciousness, mood, affect
- Skin: examine for signs of self-harm, color, temperature
- HEENT: pupil response, mucous membranes
- Cardiovascular: heart rate, rhythm, murmurs
- Respiratory: lung sounds, respiratory effort
- Abdomen: bowel sounds, tenderness, hepatomegaly
- Neurological: mental status, orientation, reflexes
- Psychiatric: mood, affect, thought process, suicidal ideation
Assessment Note:
A.O. is a 19 y/o female brought to the ED by EMS with complaint of abdominal pain and nausea after ingesting acetaminophen with intent to commit suicide around 2000 hours. Patient has a past medical history of a previous suicide attempt in high school. Physical exam reveals AAOx4, Weight 127.6, BMI: 22.7, Height: 5’3″, T: 99.1, P: 68, BP: 116/74, R: 12, O2: 96% on room air. Lung sounds clear bilaterally. No edema noted. Skin intact besides scars on bilateral thighs. Abdomen is non-tender.
Diagnosis: Acute acetaminophen ingestion with major depressive disorder and suicidal ideation
Plan:
- Determine need for N-acetylcysteine (NAC) based on serum acetaminophen levels and time of ingestion
- Monitor vital signs q1hr x4, then q2hr, then q4hr; maintain NPO status
- Suicide precautions until psychiatric evaluation
- Comprehensive mental health assessment
- Laboratory monitoring including acetaminophen level, liver function tests, coagulation studies
- Psychiatry consultation for ongoing mental health treatment
Amka Oxendine SOAP Note
Patient: Amka Oxendine
Subjective Data
CC: 19-year-old female presents with “abdominal pain and nausea after taking too many Tylenol”
HPI: 19-year-old female college student presents today after ingesting 15 extra-strength acetaminophen tablets with suicidal intent following a breakup with her boyfriend. The ingestion occurred approximately 4 hours prior to presentation. Patient reports feeling regretful about the ingestion and called EMS herself. She describes mild abdominal discomfort and nausea but denies vomiting. Patient reports this suicide attempt was triggered by recent relationship breakup and ongoing struggles with college adjustment. She describes feeling overwhelmed with academic demands, social isolation, and depressed mood over the past several months.
Medications: None currently prescribed
Allergies: NKDA (No Known Drug Allergies)
PMH: History of depression and previous suicide attempt at age 15 during high school. Denies other chronic medical conditions.
PSH: Denies any surgical procedures.
Sexual History: Deferred for this emergency visit.
Hospitalizations: Previous psychiatric hospitalization following suicide attempt at age 15.
Family History: Family history of depression (maternal side). Denies family history of substance abuse or other psychiatric conditions.
Substances: Denies alcohol, tobacco, or illicit drug use in past 24 hours. Occasional social drinking on weekends. Denies regular tobacco or drug use.
Home environment: Lives in college dormitory. Reports safe physical environment but significant psychosocial stressors.
Employment/Education: College freshman struggling academically with failing grades in multiple courses.
Social Support: Reports few friends at college, feeling socially isolated, recent breakup with boyfriend who was primary emotional support.
Objective Data
ROS:
- General: Reports fatigue, decreased interest in normal activities, appetite changes, and sleep disturbances.
- GI: Mild nausea, denies vomiting, mild abdominal discomfort
- Neurologic: Denies headache, dizziness, confusion
- Psychiatric: Endorses depressed mood, anhedonia, feelings of worthlessness, and intermittent suicidal ideation
Vital Signs: Temperature: 99.1°F, Pulse: 68, BP: 116/74, Respirations: 12, SpO2: 96% on room air
Assessment
General: 19-year-old female appears stated age, alert and oriented x4. Cooperative with examination. Mood appears depressed with flat affect.
Skin: Skin intact, warm and dry. Scars noted on bilateral thighs consistent with previous self-harm. No signs of current self-injury.
HEENT: Head normocephalic, pupils equal and reactive to light. Mucous membranes moist. No signs of trauma.
Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops. Pulses 2+ bilaterally.
Respiratory: Lung sounds clear bilaterally. Respirations unlabored, symmetric chest expansion.
Abdomen: Abdomen soft, non-tender to palpation. Bowel sounds present in all quadrants. No hepatomegaly or masses.
Neurologic: Alert and oriented x4. Speech clear and coherent. No focal neurologic deficits.
Psychiatric: Depressed mood and flat affect. Admits to recent suicidal ideation but denies current active suicidal thoughts. Denies homicidal ideation. Expresses some regret about overdose.
Differential Diagnoses
Acute Acetaminophen Toxicity: Patient presents with known ingestion of 15 extra-strength acetaminophen tablets approximately 4 hours prior. Time frame and quantity place patient at risk for hepatotoxicity, requiring immediate serum acetaminophen level and potential N-acetylcysteine therapy.
Major Depressive Disorder with Suicidal Ideation: Patient has history of depression and previous suicide attempt, with current presentation of intentional overdose. Reports classic symptoms of depression including anhedonia, appetite changes, sleep disturbances, and feelings of worthlessness.
Adjustment Disorder: Recent significant psychosocial stressors including college adjustment difficulties, academic failure, social isolation, and relationship breakup may contribute to current mental health crisis.
Acute Stress Reaction: Recent breakup and academic stressors may have precipitated impulsive suicidal behavior in context of underlying depression.
Most Likely Diagnosis: Acute acetaminophen ingestion secondary to major depressive disorder with suicidal ideation, precipitated by recent psychosocial stressors.
Plan
Immediate Medical Management:
Toxicology Assessment:
- Obtain serum acetaminophen level immediately and plot on Rumack-Matthew nomogram
- Initiate N-acetylcysteine (NAC) if acetaminophen level indicates risk for hepatotoxicity
- Standard NAC protocol: Loading dose 150 mg/kg IV over 1 hour, followed by 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours
- Monitor liver function tests, PT/INR, and basic metabolic panel
Supportive Care:
- NPO status until cleared by physician
- Vital signs monitoring every hour x4, then every 2 hours, then every 4 hours
- IV hydration as needed
- Anti-nausea medication as appropriate
Mental Health Management:
Immediate Safety:
- One-to-one supervision with suicide precautions until psychiatric evaluation
- Remove potentially harmful objects from environment
- Psychiatric consultation for comprehensive mental health evaluation
Assessment:
- Complete suicide risk assessment
- Evaluate need for inpatient psychiatric hospitalization versus intensive outpatient treatment
- Assess family support and social resources
Discharge Planning:
Community Resources:
- Referral to intensive outpatient program (IOP) for ongoing mental health treatment
- Provide crisis hotline numbers for 24/7 support
- Follow-up with psychiatry for medication management if indicated
- Coordinate with college counseling services
Health Promotion:
- Psychoeducation about depression and suicide prevention
- Coping strategy development and stress management techniques
- Safety planning with identified support persons
- Academic support services referral
Complete Step-by-Step Guide to Writing the Amka Oxendine iHuman Case Study
Completing the Amka Oxendine iHuman case requires a systematic approach that integrates both toxicology management and mental health assessment. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.
Step 1: Pre-Case Preparation and Initial Approach
Before diving into the case, review the doorway information and formulate your initial clinical approach.
Key Information to Note:
- 19-year-old female with acetaminophen overdose and suicidal intent
- Approximately 4 hours post-ingestion
- Consider dual priorities: toxicology management and mental health assessment
Initial Clinical Mindset: Approach this case with both medical toxicology and psychiatric priorities. The timing and quantity of acetaminophen ingestion places the patient at potential risk for hepatotoxicity, while the intentional nature requires comprehensive suicide risk assessment.
Step 2: Conducting the History of Present Illness (HPI)
The HPI is crucial for establishing both the toxicological and psychiatric aspects of the case. Use systematic questioning:
Toxicology History:
- Substance Details: Ask specifically about quantity (15 extra-strength acetaminophen), time of ingestion, and concurrent substances
- Timing: Precise time of ingestion is critical for acetaminophen toxicity assessment
- Symptoms: Current nausea, abdominal pain, any vomiting
Mental Health History:
- Intent: Clarify suicidal intent and circumstances surrounding the overdose
- Precipitants: Recent breakup, academic struggles, social isolation
- Current Risk: Assess current suicidal ideation and safety
Step 3: Past Medical and Psychiatric History
Psychiatric History:
- Previous suicide attempt at age 15
- History of depression and any previous mental health treatment
- Family history of mental health conditions
Medical History:
- Current medications and allergies
- Previous hospitalizations
- Substance use history
Step 4: Physical Examination Strategy
Perform a focused physical exam addressing both toxicology and mental health concerns:
Toxicology Assessment:
- Vital signs for hemodynamic stability
- Abdominal examination for tenderness or hepatomegaly
- Neurological assessment for mental status changes
Mental Health Assessment:
- Mental status examination
- Examine for evidence of self-harm (scars noted on bilateral thighs)
- Assessment of mood, affect, and thought process
Step 5: Developing Differential Diagnoses
Propose appropriate differentials addressing both medical and psychiatric aspects:
Primary Medical Diagnosis:
- Acute acetaminophen ingestion with potential for hepatotoxicity
Primary Psychiatric Diagnosis:
- Major depressive disorder with suicidal ideation
- Adjustment disorder with depressed mood
Rule Out:
- Other toxic ingestions
- Acute medical conditions causing altered mental status
Step 6: Diagnostic Test Interpretation
Critical Laboratory Studies:
- Serum acetaminophen level plotted on Rumack-Matthew nomogram
- Liver function tests (AST, ALT, bilirubin)
- PT/INR and basic metabolic panel
- Consider drug screen if polysubstance use suspected
Step 7: Management Plan Development
Immediate Medical Management:
- N-acetylcysteine therapy if indicated by nomogram
- Supportive care with monitoring and NPO status
Mental Health Management:
- Suicide precautions with one-to-one observation
- Psychiatric consultation for comprehensive evaluation
Disposition Planning:
- Consider need for inpatient psychiatric hospitalization versus intensive outpatient treatment
- Coordinate community mental health resources and follow-up
Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)
Primary Diagnosis: Acute acetaminophen ingestion secondary to major depressive disorder with suicidal ideation
MSAP Selection: Choose “Acute acetaminophen ingestion” as your Most Significant Active Problem, as this represents the immediate life-threatening condition requiring urgent medical intervention.
Step 9: Comprehensive Care Planning
Medical Follow-up:
- Continue NAC therapy as indicated and monitor liver function
- Serial laboratory monitoring until acetaminophen levels undetectable
Mental Health Follow-up:
- Intensive outpatient program referral
- Crisis intervention planning
- Family involvement and support system activation
Step 10: Documentation and SBAR Note
SBAR Format:
- Situation: 19-year-old female brought by EMS after acetaminophen overdose with suicidal intent
- Background: History of depression, previous suicide attempt, recent psychosocial stressors
- Assessment: Stable vital signs, alert and oriented, requires toxicology management and psychiatric evaluation
- Recommendation: NAC therapy as indicated, suicide precautions, psychiatric consultation
Only a few hours left for your iHuman case study?
Send us the brief, and we’ll deliver it fast
Amka Oxendine iHuman Case Summary
Grading Criteria:
The Amka Oxendine iHuman case evaluates your ability to manage both toxicological emergencies and mental health crises. Here’s what you need to focus on to maximize your score:
(1) History Taking (Major Points):
You must ask comprehensive questions about both the overdose and mental health status. Essential questions include: exact quantity and timing of acetaminophen ingestion, concurrent substance use, suicidal intent and planning, previous mental health history, current mood and ideation, precipitating stressors, and support systems. The rubric specifically rewards students who thoroughly assess suicide risk and obtain accurate toxicology history.
(2) Physical Examination (High Weight):
Focus your exam on both toxicology assessment and mental health evaluation. Must-do components: comprehensive vital signs, abdominal examination for tenderness or hepatomegaly, neurological assessment for mental status changes, examination for signs of self-harm, and mental status examination including mood, affect, and thought process.
(3) Differential Diagnosis (Critical for Scoring):
You need to propose appropriate differentials addressing both medical and psychiatric aspects. Expected differentials include: acute acetaminophen toxicity, major depressive disorder with suicidal ideation, adjustment disorder, and rule out other toxic ingestions. The rubric rewards students who understand the timing-dependent nature of acetaminophen toxicity.
(4) Final Diagnosis & MSAP:
You must correctly identify acute acetaminophen ingestion as your primary medical diagnosis while also addressing the underlying mental health condition. Justification should cite the timing, quantity, and circumstances of ingestion.
(5) Management Plan (Heavily Weighted):
The rubric expects comprehensive management including: acetaminophen level measurement and NAC therapy as indicated, suicide precautions and psychiatric consultation, appropriate monitoring and supportive care, and discharge planning with mental health resources.
(6) Safety Assessment:
Demonstrate understanding of both medical toxicity risk and ongoing suicide risk. Include assessment of need for psychiatric hospitalization and safety planning.
Example of a High-Scoring Clinical Summary
Patient Summary – Amka Oxendine
Situation: 19-year-old female college student presenting 4 hours after intentional ingestion of 15 extra-strength acetaminophen tablets with suicidal intent.
Background: Significant psychiatric history including previous suicide attempt at age 15 and ongoing depression. Recent psychosocial stressors include academic failure, social isolation, and relationship breakup.
Assessment: Patient presents with stable vital signs and mild GI symptoms. Mental status examination reveals depressed mood with flat affect. Given timing and quantity of ingestion, patient requires immediate acetaminophen level and potential NAC therapy. Ongoing suicide risk necessitates psychiatric evaluation and safety precautions.
Recommendation:
- Immediate serum acetaminophen level with NAC therapy per Rumack-Matthew nomogram
- Suicide precautions with one-to-one observation until psychiatric clearance
- Psychiatric consultation for comprehensive mental health evaluation
- Discharge planning with intensive outpatient mental health services and safety planning
Patient Education Provided: Explained acetaminophen toxicity risks, importance of mental health treatment, and provided crisis resources for ongoing support.
Conclusion
By following this comprehensive approach to the Amka Oxendine case, you’ll demonstrate the clinical reasoning skills that iHuman evaluates. Success in toxicology and mental health cases requires understanding both the medical urgency of potential acetaminophen hepatotoxicity and the psychiatric complexity of suicide risk assessment. Remember to treat each iHuman simulation as you would a real patient encounter – prioritize safety, think systematically about both medical and psychiatric aspects, and always consider the patient’s psychosocial context. With this guide, you’re well-prepared to excel in this challenging but essential case simulation.
Frequently Asked Questions
What is the correct diagnosis for Amka Oxendine’s presentation?
Amka Oxendine’s primary diagnosis is acute acetaminophen ingestion secondary to major depressive disorder with suicidal ideation. The key distinguishing features include the intentional ingestion of 15 extra-strength acetaminophen tablets approximately 4 hours prior to presentation, requiring immediate toxicological assessment and potential N-acetylcysteine therapy. The underlying psychiatric condition involves major depression with history of previous suicide attempt, precipitated by recent psychosocial stressors.
What are the critical assessment components I need to perform to score well?
Essential assessment elements include obtaining precise timing and quantity of acetaminophen ingestion for toxicology evaluation, comprehensive suicide risk assessment including current ideation and safety planning, mental status examination, physical examination focusing on abdominal assessment and signs of self-harm, and evaluation of precipitating psychosocial stressors. Students often miss points by not emphasizing the time-dependent nature of acetaminophen toxicity assessment.
How do I pass the Amka Oxendine case and meet the 70% requirement?
You must score a cumulative 70% by demonstrating competency in both toxicological and psychiatric assessment. Focus on systematic history-taking that addresses both overdose details and mental health status, comprehensive physical examination including safety assessment, appropriate differential diagnoses that consider both medical and psychiatric conditions, and integrated management plan addressing immediate medical needs and ongoing psychiatric care. The key is understanding dual priorities: medical stabilization and suicide risk management.
What management interventions should I include in my treatment plan?
The comprehensive management plan should address both acute toxicological management and ongoing mental health needs. Include immediate serum acetaminophen level measurement with N-acetylcysteine therapy as indicated by the Rumack-Matthew nomogram, suicide precautions with constant observation until psychiatric evaluation, psychiatric consultation for comprehensive mental health assessment, and discharge planning with intensive outpatient mental health services, crisis resources, and family involvement. Students often miss points by not addressing both the immediate medical emergency and the underlying psychiatric condition requiring ongoing treatment.