Friday, January 29, 2016

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
  1. Emergency and Supportive Measure
  2. Maintain an open airway and assist ventilation if necessary
  3. Gastric lavage (if few hours after ingestion) followed by activated charcoal
  4. 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 3rd edition
2. Poisoning & Drug Overdose 3rd edition

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