GENERAL AND SUPPORTIVE MEASURES
- Ensure safety of patient, caregivers, staff members and the environment.
- De-escalation techniques first-line to try to calm the patient.
- Physical restraint should only be used to protect the patient and caregivers; for the shortest period and should be monitored very 10-20 minutes.
- A thorough physical examination must be done.
- Exclude general medical causes e.g. intracranial pathology like encephalopathy, seizures, metabolic disease, medication adverse effects and intoxication.
Investigations to exclude medical causes:
- Baseline BMI.
- Baseline laboratory work-up: FBC, urea and creatinine, electrolytes, AST, ALT, TSH, fasting glucose.
- Monitor for extrapyramidal side effects e.g. acute dystonia.
MEDICATION TREATMENT
For children under the age of six years:
Sedation with psychotropic agents should only be considered in extreme cases and only after consultation with a specialist.
For children over the age of six years:
- Lorazepam, oral/IM.
- 0.05 – 0.1 mg/kg/dose.
- Onset of action: 20 - 40 minutes.
If sedation is inadequate:
- Haloperidol, IM.
- 0.025–0.05mg/kg/day.
- Onset of action 20 - 30 minutes.
- Maximum dose: 0.15 mg/kg/day.
In case of an acute dystonic reaction secondary to haloperidol:
- Biperiden, IM/slow IV, 0.05–0.1 mg/kg.
- 1 - 6 years: 2mg.
- 7 – 10 years: 3 mg.
- > 10 years: 5 mg.