Sedation
An oral benzodiazepine is usually adequate for cooperative patients who have mild to moderate agitation or who have received physostigmine. Use:
diazepam 5 to 20 mg (child: 0.2 mg/kg up to 10 mg) orally; repeat after 30 minutes if required. Usually no more than 120 mg is required in 24 hours. anticholinergic toxidrome - sedation diazepam
For patients with severe anticholinergic toxidrome (including anticholinergic delirium), if physostigmine is not available, a parenteral sedative is required to control behavioural disturbance. For poisonings due to antipsychotic drugs, sedation with another antipsychotic drug, such as droperidol, is contraindicated.
For adults, use:
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 hours12 anticholinergic toxidrome - sedation
OR
2 diazepam 5 to 10 mg intravenously over 2 to 5 minutes, every 10 minutes until the patient is sedated but rousable. Maximum dose is 30 mg per event and 60 mg in 24 hours3
OR
2 midazolam 2.5 to 5 mg intravenously, every 3 to 4 minutes until the patient is sedated but rousable. Maximum dose is 20 mg per event. anticholinergic toxidrome - sedation midazolam
For children, use:
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
OR
2 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
OR
2 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. midazolam
Avoid physical and mechanical restraints if possible; they should only be used in conjunction with pharmacological management for short periods.