Haloperidol Poisoning Management

Clinical presentation of poisoning

SEVERITY	CLINICAL PRESENTATION
MILD	Sedation, small pupils, orthostatic hypotension. Anticholinergic symptoms: Dry mouth, absence of sweating, increased heart rate, urinary retention
SEVERE	Coma, seizures, respiratory arrest ECG- shows QT prolongation and occasionaly QRS prolongation Hypothermia or Hyperthermia may occur
Extrapyrimidal side effects- Jaw muscle spasm, rigidity, bradykinesia, pill-rolling tremor, rolling of the eye ball

MANAGEMENT AND TREATMENT

Emergency and Supportive Measure Maintain an open airway and assist ventilation if necessary Gastric lavage (if few hours after ingestion) followed by activated charcoal Cardiac monitoring for at least 24-48hr.
Symptoms	Adult dose	Children Dose
Acute dystonic reactions	Give IV Diazepam 0.1-0.2mg/kg, OR IM/IV Diphenhydramine 0.5-1mg/kg  OR Anticholinergic agent (eg: Oral, IM, or IV Benztropine 1-2mg, bd or tds	IV,IM, or oral Benztropine: 20 micrograms/kg (unlicensed indication
Hypotension	Fluid administration using normal saline 10-20ml/kg, and alpha-adrenergic agent (eg:Noradrenaline, Phenylephrine)	Up to 20ml/kg/dose titrate to hypotension reversal (Lexicomp indication for hypovolemic septic shock)
Ventricular Arrythmias Recurrent Torsades de pointes	**Lignocaine, Phenytoin. Severe QT prolongation may need Magnesium Severe QRS prolongation treat with Sodium Bicarbonate 1-2mEq/kg IV bolus and repeat as necessary Magnesium, Isoprenaline or overdrive pacing Overdrive pacing is preferred IV Isoprenaline 0.2 micrograms/minute and titrated to maintain a heart rate of 100 beats per minute IV Magnesium sulphate 8mmol over 10-15 minutes, repeated once if necessary	Magnesium : Clinical experience in children is lacking, but based on the recommendations for management in  adults, doses of 0.08-0.2 mmol/kg (0.04-0.1 ml/kg of 50% solution) may be considered appropriate
Seizures	IV Diazepam 0.1-0.2 mg/kg	**Dosing specifically in poisoning case is not present.

** Dosings for these medications in poisoning cases were not extensively studied, suggest to use dosing recommendation for the respective indication it is used for

REFERENCES

1. Sarawak Handbook 3^rd edition

2. Poisoning & Drug Overdose 3^rd edition

3. http://www.inchem.org/documents/ukpids/ukpids/ukpid24.htm