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Anti-NMDA Receptor Encephalitis — Pharmacological Management of Paroxysmal Sympathetic Hyperactivity — Clinical Pathway: Inpatient

Pharmacological Management of
Paroxysmal Sympathetic Hyperactivity

PSH Identified
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Autonomic Symptoms
Tachycardia, hypertension, diaphoresis, temperature instability, tachypnea
Agitation Symptoms
Motor Symptoms
Dystonia, spasticity
Autonomic Symptoms
Tachycardia, hypertension, diaphoresis, temperature instability, tachypnea
Agitation Symptoms
Motor Symptoms
Dystonia, spasticity
 
 
 
 
 
 
 
 
 
 
 
 
Consider First Line
Benzodiazepines
Consider First Line
Baclofen and/or Gabapentin
 
 
 
 
 
 
 
 
 
 
Treatment Effective?
Consider Next Line
Benzodiazepines
Consider Next Line
Benzodiazepines and/or Gabapentin
 
 
 
 
 
 
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

 

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