Sedation
In sympathomimetic toxidrome, treat CNS excitation, including severe agitation, with sedation using intravenous benzodiazepines. Intravenous benzodiazepines are also indicated for tachycardia and hypertension associated with sympathomimetic toxidrome. Large doses are often required for adequate control.
For adults, use:
1 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 hours1 sympathomimetic toxidrome - adult
OR
1 midazolam 2.5 to 5mg intravenously, every 3 to 4 minutes until the patient is sedated but rousable. Maximum dose is 20 mg per event. sympathomimetic toxidrome - adult midazolam
For children, use:
1 diazepam 0.05 to 0.1 mg/kg up to 5 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 hours1 sympathomimetic toxidrome - child
OR
1 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. sympathomimetic toxidrome - child midazolam
If there is no improvement with an intravenous benzodiazepine, for severe agitation in a patient with signs of excited delirium, use droperidol.
For adults, use:
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 hours23. sympathomimetic toxidrome - adult
For children, use:
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 event2. sympathomimetic toxidrome - child
For a cooperative patient with mild to moderate agitation, an oral benzodiazepine may be adequate. 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. sympathomimetic toxidrome - oral diazepam