Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department.
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.
UCSF-Fresno, Department of Emergency Medicine, Fresno, CA, USA; Community Regional Medical Center, Fresno, CA, USA. Electronic address: rramirez@fresno.ucsf.edu.
Rene
R
Ramirez
UCSF-Fresno, Department of Emergency Medicine, Fresno, CA, USA; Community Regional Medical Center, Fresno, CA, USA.
Philip
P
Stalcup
UCSF-Fresno, Department of Emergency Medicine, Fresno, CA, USA; Community Regional Medical Center, Fresno, CA, USA.
Brandon
B
Croft
UCSF-Fresno, Department of Emergency Medicine, Fresno, CA, USA; Community Regional Medical Center, Fresno, CA, USA.
Michael A
MA
Darracq
D015746:Abdominal Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D002140:California; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D018589:Gastroparesis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D017408:Guidelines as Topic; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009325:Nausea; D012189:Retrospective Studies; D016896:Treatment Outcome; D014839:Vomiting; D055815:Young Adult
D000932:Antiemetics; D006220:Haloperidol