Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department

• Published in: The American journal of emergency medicine 2017-08, Vol.35 (8), p.1118-1120
• Main Authors: Ramirez, Rene, MD, Stalcup, Phillip, MD, Croft, Brandon, BS, Darracq, Michael A., MD, MPH
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Pain - diagnosis; Abdominal Pain - drug therapy; Abdominal Pain - etiology; Adult; Analgesia; Analgesics; Anesthesia; Antiemetics; Antiemetics - therapeutic use; California; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - physiopathology; Dopamine; Electronic medical records; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Gastroparesis - diagnosis; Gastroparesis - drug therapy; Gastroparesis - etiology; Guidelines as Topic; Haloperidol; Haloperidol - therapeutic use; Humans; Injections, Intramuscular; Male; Medical electronics; Middle Aged; Morphine; Narcotics; Nausea; Opioids; Pain; Pain perception; Patients; Psychotropic drugs; Retrospective Studies; Statistical analysis; Treatment Outcome; Vomiting; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.03.015

Abstract Background Gastroparesis associated nausea, vomiting & abdominal pain (GP N/V/AP) are common presentations to the emergency department (ED). Treatment is often limited to antiemetic, prokinetic, opioid, & nonopioid agents. Haloperidol (HP) has been shown to have analgesic & antiemetic properties. We sought to evaluate HP in the ED as an alternative treatment of GP N/V/AP. Methods Using an electronic medical record, 52 patients who presented to the ED w/GP N/V/AP secondary to diabetes mellitus and were treated w/HP were identified. Patients who received HP were compared to themselves w/the most recent previous encounter in which HP was not administered. ED length of stay (LOS), additional antiemetics/prokinetics administered, hospital LOS, and morphine equivalent doses of analgesia (ME) from each visit were recorded. Descriptive statistics, categorical (Chi Square Test or Z-Test for proportion) and continuous (Wilcoxon Signed Rank Test) comparisons were calculated. Statistical significance was considered for two tail p-values less than 0.05. Results A statistically significant reduction in ME (Median 6.75 [IQR 7.93] v 10.75 [IQR12]: p = 0.001) and reduced admissions for GP (5/52 v 14/52: p = 0.02) when HP was administered was observed. There were no statistically significant differences in ED or hospital LOS, and additional antiemetics administered between encounters in which HP was administered and not administered. No complications were identified in patients who received HP. Conclusions The rate of admission and ME was found to be significantly reduced in patients with GP secondary to diabetes mellitus who received HP. HP may represent an appropriate, effective, and safe alternative to traditional analgesia and antiemetic therapy in the ED management of GP associated N/V/AP.