Overdose and toxicology — structured clinical viva

Reject premature transfer. Venlafaxine is not risk-equivalent to many SSRIs in overdose; relative toxicity data place it closer to higher-risk agents for seizures and serious outcomes. She already seized — she needs medical observation, monitoring, and toxin work-up, not an immediate psych-ward bed.[1][2][5]

Immediate priorities. ABCDE, continuous monitoring, glucose, ECG serial review, benzodiazepines for recurrent seizures, timed paracetamol level and NAC if indicated, basic labs, early toxicology advice. Airway vigilance if GCS falls.[3][4]

Disposition thinking. Observe through expected peak effects; escalate to ICU if status epilepticus, airway compromise, or progressive cardiotoxicity. Only after medical clearance: structured suicide risk assessment, means restriction (dispose stock, safer future prescribing), and least-restrictive safe psychiatric plan.[4]