UMEM Educational Pearls

Takeaways

Take Home Point: In patients with diabetic gastroparesis, haloperidol may be an effective adjunctive treatment to prevent hospitalizations and reduce opioid requirements. 

In-Depth

In Depth:  

Study Design: single-center, retrospective review, case-matched to prior visit for gastroparesis  

Patients: 

  • 52 patients with previously diagnosed diabetic gastroparesis by gastric motility study who presented to the ED for gastroparesis treatment 

Groups: 

  • Haloperidol administered visit 

  • Haloperidol NOT administered visit (most recent visit, >7 days prior to haloperidol visit) 

Results: 

  • Baseline characteristics: median age 32 (21-57), 62% (32/52) female 

  • Statistically significant reduction in hospital admissions for the haloperidol visit: (5/52 [10%] [CI 3-21%]) vs the non-haloperidol visit (14/52 [27%] [CI 16-41%]) p=0.02 

  • Statistically significant reduction in opioid administration during the haloperidol visit: 6.75 ME (IQR 7.93) vs 10.75 ME (IQR 12) p=0.009 

  • No difference in ED LOS, hospital LOS or need for additional antiemetics/prokinetics 

  • No dystonic reactions, akathesia, excessive sedation, or cardiovascular complications in patients who received haloperidol 

Limitations: 

  • Small, single-center, retrospective study that only included patients with diabetic gastroparesis 

  • Only intramuscular administration was studied 

  • Baseline QT not reported 

  • Young patient population, no description of comorbidities or home medications 

Conclusions: 

  • Haloperidol may be considered as an adjunctive therapy in patients with diabetic gastroparesis for its antiemetic and analgesic properties. Prospective studies are necessary to confirm findings.

 

References

Ramirez R, Salcup P, Croft B, Darracq MA. Am J Emerg Med 2017;35:1118-1120.