Pharmacological Management of
Paroxysmal Sympathetic Hyperactivity
- Related Pathways
PSH Identified
Autonomic Symptoms
Tachycardia, hypertension, diaphoresis, temperature instability, tachypnea
Tachycardia, hypertension, diaphoresis, temperature instability, tachypnea
Agitation Symptoms
Motor Symptoms
Dystonia, spasticity
Dystonia, spasticity
Autonomic Symptoms
Tachycardia, hypertension, diaphoresis, temperature instability, tachypnea
Tachycardia, hypertension, diaphoresis, temperature instability, tachypnea
Agitation Symptoms
Motor Symptoms
Dystonia, spasticity
Dystonia, spasticity
Consider First Line
Benzodiazepines
Benzodiazepines
- If Tachycardia Predominant
Consider Propranolol - If Hypertension Predominant
Consider Propranolol
and/or Clonidine, Dexmedetomidine (ICU Only) - If Hyperthermia Predominant
Consider Bromocriptine
Treatment Effective?
Consider Next Line
Benzodiazepines
Benzodiazepines
Treatment Effective?
Yes
No
Monitor and reassess
Consider dose optimization and/or alternative therapies or alternative diagnoses
Yes
No
Monitor and reassess
- If medications optimized
but child still having
PSH symptoms:- Revisit environmental measures
- Rule out delirium
- Consider noxious stimuli triggers:
- Acute pain
- Suctioning
- Loud noises
- Repositioning
- Urinary retention
- Increased tone
- Acute illness