Toxicology

Dexmedetomidine

α2-receptor agonist, which may help control BP and HR; however, it will not prevent seizures.

May reduce overall benzodiazepine requirements; however, it lacks the activity necessary to

prevent seizures.

Recommended when clonidine cannot be administered and as adjunct therapy

encephalopathy and hypomagnesemia. High dose intravenous folic acid, thiamine, and magnesium

should be administered to nutrient-deficient patients. Dextrose containing fluids may also be considered

Clinical Institute Withdrawal Assessment for Alcohol Scale (revised version) (CIWA-Ar) or the

Minnesota Detoxification Scale (MINDS) to determine the severity of symptoms and treatment

in intubated patients to guide benzodiazepine dosing.

Vital signs every 2–4 hours

Electroencephalogram for sustained seizure-related activity

Agent

Suggested Starting Dose

Suggested Interval/Infusion Dose Range

Diazepam

5–20 mg PO/IV

Every 6–8 hr

Lorazepam

2–4 mg PO/IV

Every 4–6 hr

Phenobarbital

65– 260 mg or 10 mg/kg IV

Every 15–20 min until symptoms are controlled

Clonidine

0.1–0.3 mg PO

Every 8–12 hr

Baclofen

5–10 mg PO

Every 8–12 hr

Gabapentin

600–800 mg PO

Every 8 hr

Propofol

10–20 mcg/kg/min IV

20–70 mcg/kg/min

Dexmedetomidine

0.2–0.4 mcg/kg/hr IV

0.4–1.5 mcg/kg/hr

Ketamine

0.15–0.2 mg/kg/hr IV

0.2–0.3 mg/kg/hr

Thiamine

100–500 mg IV

Every 8–24 hr for 3–5 days

Folic acid

1–5 mg IV

Once daily for 3–5 days

Magnesium

1–4 g IV

Once daily for 3–5 days

IV = intravenously; PO = orally or per tube.

Cardiovascular agents accounted for a little more than 110,000 toxic exposures in 2022 and were a

leading cause of death secondary to pharmaceutical exposure.

(28,547 cases and 23 deaths in 2022) and calcium channel blockers (15,718 cases and 30 deaths in 2022).