Sympathomimetic Toxicity Treatment & Management
- Author: Paul Kolecki, MD, FACEP; Chief Editor: Asim Tarabar, MD more...
Managing the airway and controlling agitation are the two main prehospital treatment concerns. Many patients with sympathomimetic poisoning present in an agitated state. In these cases, physical and/or chemical restraint may be required.
A rapid bedside blood sugar test (eg, Accu-Chek) should be performed to rule out hypoglycemia. Hypoglycemia should be treated if detected.
Emergency Department Care
General supportive care is the main treatment measure for sympathomimetic toxicity because no antidote exists. Assessment of the airway, breathing, and circulation immediately is recommended. In addition, close monitoring of the vital signs is recommended.
Sympathomimetic toxicity is frequently associated with significant agitation, thus necessitating the use of physical restraints and chemical sedation. However, physically restrained patients with sympathomimetic-associated agitation or hyperthermia have an associated significant risk of sudden death. The liberal use of chemical sedation in such instances is strongly recommended. Benzodiazepines (eg, Valium) are the safest first approach in calming sympathomimetic-poisoned patients. They should be administered frequently in titrated doses.
Consider gastric decontamination for oral ingestions of sympathomimetic agents. Gastric decontamination is associated with subsequent vomiting and aspiration. Thus, airway control is strongly recommended prior to any gastric decontamination. In addition, the patient's airway, breathing, circulation, and agitation should be stabilized before performing GI decontamination.
It is imperative to measure the core temperature of sympathomimetic poisoned patients. If hyperthermia is present, standard cooling measures should be initiated. Controlling agitation significantly helps in cooling a hyperthermic patient.
Hypertension unresponsive to sedation should be treated with a rapidly acting and easily titrated agent (eg, sodium nitroprusside).
Seizures should be rapidly controlled with benzodiazepines and/or barbiturates. Obtaining a CT scan of the brain for all sympathomimetic toxic patients who seize, develop a focal neurologic deficit, or experience a severe headache with or without accompanying hypertension is recommended.
Consultation from the regional poison control center or a local medical toxicologist (certified by the American Board of Medical Toxicology and/or the American Board of Emergency Medicine) for additional information and patient care recommendations is recommended.
Prolonged critical care management often is required for the numerous complications that may occur with the severe overdose (eg, hyperthermia, seizures, advanced respiratory distress syndrome [ARDS], renal failure, rhabdomyolysis, CNS dysfunction).
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