Sympathomimetic Agent Poisoning

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

---

ICD-10 codes: T43.6/F14

DESCRIPTION

Pseudoephedrine in decongestants, methylphenidate and illicit drugs such as cocaine and amphetamines ('Tik') are sympathomimetic agents.  These agents are frequently abused as recreational drugs.

DIAGNOSTIC CRITERIA

Clinical

• hypertension,
• tachycardia,
• tachypnoea,
• agitation,
• psychosis,
• dilated pupils,
• diaphoresis,
• hyperthermia: effects of sympathomimetics that predispose to hyperthermia include:
  • peripheral vasoconstriction and impaired cutaneous heat loss,
  • agitation,
  • seizures,
  • increased muscle activity,
  • impaired behavioural response.
• With cocaine toxicity, cardiovascular manifestations predominate, including:
  • supraventricular and ventricular dysrhythmias,
  • myocardial ischaemia.
• Neonates of mothers addicted to cocaine may present with withdrawal signs, manifested by jitteriness.

Investigations

• ECG monitoring to evaluate dysrhythmias.

GENERAL AND SUPPORTIVE MEASURES

• Admit all seriously ill children to ICU.
• Maintain hydration.
• Cooling for hyperthermia.
• Mildly toxic patients require no specific treatment.

MEDICINE TREATMENT

• Activated charcoal, See: Poisoning, Treatment.

For agitation and tachycardia:

• Diazepam, IV/oral, 0.1–0.2 mg/kg.
  • Maximum dose of 10 mg.

For severe hypertension:

See: Hypertension, acute severe.

For seizures:

See: Status epilepticus (convulsive).

REFERRAL

• Status epilepticus requiring ICU.
• Hypertensive crisis.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 18: Poisoning,  18.1 Poisoning,  18.1.16 Sympathomimetic Agent Poisoning