Sedation for poisonings

Sedation may be required to manage agitation in patients in poisonings. Verbal de-escalation may be adequate in some situations (see Verbal de-escalation and psychological intervention). For the management of acute behavioural disturbances unrelated to poisoning, see Approach to managing acute behavioural disturbance.

For the management of agitation related to specific drugs or toxins, see individual monographs.

For the management of agitation related to toxidromes, see advice in:

In agitated patients, when the cause of poisoning is unknown, oral benzodiazepines are the initial treatment of choice, if the patient is willing to take them. Use:

diazepam 5 to 20 mg (child: 0.2 mg/kg up to 10 mg) orally; repeat every 30 minutes if required. Usually no more than 120 mg is required in 24 hours. sedation for poisonings - oral diazepam

In difficult cases, where agitation is not manageable with oral therapy, suitable parenteral alternatives for adults are:

1 droperidol 5 to 10 mg intravenously or intramuscularly; repeat once after 15 minutes if required. Maximum dose is 20 mg per event and 30 mg in 24 hours¹ ² sedation for poisonings - adult

2 midazolam 2.5 to 5 mg intravenously or intramuscularly, every 3 to 4 minutes until the patient is sedated but rousable up to a maximum of 20 mg per event. sedation for poisonings - adult midazolam

If there is an inadequate response to the above regimens, use:

ketamine 4 to 5 mg/kg intramuscularly, as a single dose. sedation for poisonings - adult

For children, where agitation is not manageable with oral therapy, suitable parenteral regimens are:

1 droperidol 0.1 to 0.2 mg/kg up to 10 mg intramuscularly; repeat once after 15 minutes if required. Maximum dose is 0.4 mg/kg up to 20 mg per event¹ sedation for poisonings - child

2 ketamine 2 to 4 mg/kg up to 400 mg intramuscularly, as a single dose sedation for poisonings - child

3 diazepam 0.05 to 0.1 mg/kg up to 5 mg intravenously, over 2 to 5 minutes; repeat once after 15 minutes if required. Maximum dose is 0.2 mg/kg up to 10 mg per event sedation for poisonings - child

3 midazolam 0.05 to 0.1 mg/kg up to 5 mg intramuscularly or intravenously, every 3 to 4 minutes until the patient is sedated but rousable. Maximum dose is 0.4 mg/kg up to 20 mg per event. sedation for poisonings - child midazolam

¹ Sedation with antipsychotic drugs, such as droperidol, is absolutely contraindicated in neuroleptic malignant syndrome and for the management of antipsychotic drug toxicity.Return

² For patients who are frail, older than 65 years, or weigh less than 50 kg, reduce the droperidol dose to 5 mg (maximum dose is 10 mg per event and 15 mg in 24 hours).Return