A 6-year-old child is given droperidol and develops extrapyramidal symptoms. The most appropriate drug for treatment is

A 6-year-old child is given droperidol and develops extrapyramidal symptoms. The most appropriate drug for treatment is

• A. Dantrolene
• B. Thiopental
• C. Glycopyrrolate
• D. Diphenhydramine

Answer: (D)

Extrapyramidal symptoms from a dopamine-blocking drug arise because blocking dopamine in the nigrostriatal pathway tips the balance toward acetylcholine activity in the basal ganglia, producing dystonia, rigidity, and tremor. The best immediate treatment is an anticholinergic agent that can work in the central nervous system to restore that balance. Diphenhydramine fits this need well because it blocks muscarinic receptors in the brain and periphery and crosses into the CNS, providing rapid relief of acute EPS when given by IV or IM in a child. Dantrolene, by contrast, is used for malignant hyperthermia and neuroleptic malignant syndrome, not EPS. Thiopental is an induction agent with no role in treating EPS. Glycopyrrolate is an anticholinergic but is not as effective or rapid as diphenhydramine for acute dystonias in this setting.

Extrapyramidal symptoms from a dopamine-blocking drug arise because blocking dopamine in the nigrostriatal pathway tips the balance toward acetylcholine activity in the basal ganglia, producing dystonia, rigidity, and tremor. The best immediate treatment is an anticholinergic agent that can work in the central nervous system to restore that balance. Diphenhydramine fits this need well because it blocks muscarinic receptors in the brain and periphery and crosses into the CNS, providing rapid relief of acute EPS when given by IV or IM in a child.

Dantrolene, by contrast, is used for malignant hyperthermia and neuroleptic malignant syndrome, not EPS. Thiopental is an induction agent with no role in treating EPS. Glycopyrrolate is an anticholinergic but is not as effective or rapid as diphenhydramine for acute dystonias in this setting.