Manejo de Agitación Aguda en Adolescentes

Opciones de Tratamiento

La American Academy of Emergency Medicine recomienda lorazepam 2-4 mg IM/IV como primera línea para pacientes con agitación aguda y historia de consumo de sustancias psicoactivas, debido a su efectividad en cubrir posibles síndromes de abstinencia y menor riesgo de efectos extrapiramidales 1, 2
Las benzodiazepinas son tan efectivas como los antipsicóticos convencionales para controlar agitación indiferenciada, según la American Academy of Emergency Medicine 1, 3
La combinación de lorazepam 2 mg + haloperidol 5 mg IM produce sedación más rápida que la monoterapia con lorazepam, según la American Academy of Emergency Medicine 1
La American Academy of Emergency Medicine sugiere evitar antipsicóticos como monoterapia inicial si se sospecha intoxicación por agentes anticolinérgicos o simpaticomiméticos, ya que pueden exacerbar la agitación 3, 4
La American Academy of Emergency Medicine recomienda considerar la toxicología urinaria para guiar el tratamiento, incluso si el paciente reporta abstinencia, para evaluar la presencia de sustancias psicoactivas 3
La American Academy of Emergency Medicine sugiere que el lorazepam es terapéutico, no solo sintomático, si la agitación es por abstinencia alcohólica o de benzodiazepinas 2
La American Academy of Emergency Medicine recomienda monitorear signos vitales y evaluar sedación cada 5-15 minutos durante la primera hora después de la administración de medicamentos, y obtener un ECG basal si se utiliza droperidol 1, 4, 2

The American College of Emergency Physicians recommends midazolam as an alternative to lorazepam for acute agitation control, with Level B evidence supporting benzodiazepines as effective monotherapy for acutely agitated undifferentiated patients 5, 6

Midazolam provides dual benefit of controlling agitation and offering seizure prophylaxis in patients with seizure history, making it a crucial alternative to lorazepam 5, 6

The American College of Emergency Physicians suggests considering haloperidol or olanzapine as alternatives to midazolam if the agitation is primarily psychotic in nature, but notes that haloperidol does not provide seizure prophylaxis and may lower seizure threshold 5, 6

Midazolam 5 mg IM achieves adequate sedation significantly faster than lorazepam 2 mg IM, with a mean time to sedation of 18.3 minutes compared to 32.2 minutes for lorazepam, representing a clinically meaningful 14-minute difference in achieving control of dangerous agitation 7, 8
Midazolam has a shorter duration of action, with a mean time to arousal of 82 minutes, compared to 217 minutes for lorazepam, allowing for better titration and reduced risk of prolonged over-sedation 7, 8
The doses of midazolam 5 mg and lorazepam 2 mg used in clinical trials were NOT determined to be equipotent, and the guideline evidence explicitly notes this limitation 7, 8

For rapid control of acute agitation, midazolam 5 mg IM is preferred due to its faster onset of action 7, 8
When shorter duration of sedation is desirable, midazolam may be preferred, as it allows for more frequent reassessment 7, 8
When longer duration of sedation is acceptable or desired, lorazepam may be preferred 7, 8