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Acute dystonic reaction — ABEM Board MCQ

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EasyPsychiatric emergenciesAcute dystonic reactionABEM Board

A 19-year-old man arrives with painful neck twisting and upward eye deviation 2 days after starting prochlorperazine. Triage acuity is ESI 3; BP 128/76 mm Hg, HR 96/min. He is anxious but alert, with no fever, rigidity, or altered mental status. Which of the following is the most appropriate next step in management?

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Correct answer: C — Give diphenhydramine or benztropine

Acute dystonia from dopamine-blocking medication is treated with anticholinergic therapy such as diphenhydramine or benztropine.

Reference: ACEP psychiatric medication adverse effect guidance