Supportive care and decontamination of the gastrointestinal tract are the key principles of treatment in overdose with the antipsychotic agents ( Table 15.5.-.3). Patency of the airway and assurance of adequate ventilation are paramount, especially in light of the fact that these agents may cause profound alterations in level of consciousness. Oxygen and naloxone should be administered to all patients with altered mental status, and blood glucose should be rapidly assessed at the bedside.21 Crystalloid intravenous fluids should be given for hypotension. If further therapy is needed, pressors with b-adrenergic activity should be avoided (e.g., dopamine, epinephrine, and isoproterenol), because the a-adrenergic blockade seen with the antipsychotic agents results in unopposed b-adrenergic agonism, causing vasodilatation and worsening hypotension.3,1 16
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