Diabetic Gastroparesis Needs HUGS

Background: Anyone practicing in emergency medicine has taken care of a patient with diabetic gastroparesis. Although, it is not a sexy topic to discuss, nor a disease process associated with significant mortality, it is associated with decreased quality of life, and increased resource utilization due to frequent hospitalization. Furthermore, opioid analgesia, can further decrease gastric emptying and therefore worsen symptoms of abdominal pain and nausea/vomiting. Haloperidol possesses antiemetic and analgesic properties, which may be one of the reasons this medication could work in diabetic gastroparesis. The authors of this paper quite ingeniously entitled their study: Haloperidol Undermining Gastroparesis Symptoms (HUGS).

What They Did:

• Retrospective case matched observational study of 52 patients who had received 5mg IM haloperidol for the treatment of gastroparesis, nausea/vomiting, or abdominal pain
• Patients case-matched with their last visit for the same complaint without the use of haloperidol

Outcomes:

• ED Length of Stay
• Additional antiemetics/prokinetics administered
• Hospital Length of Stay
• Morphine equivalent (ME) doses of analgesia
• Hospital Admission

Results:

• No Dystonic reactions, akathisia, excessive sedation, or cardiovascular complications were observed in patients receiving haloperidol

Strengths:

• Patients included in the study had formal diagnosis of gastroparesis by a gastric motility test

Limitations:

• Retrospective, single center study
• Did not look at patients with gastroparesis secondary to disorders other than diabetes mellitus
• Small sample size: Additional cases may have significant potential to change results
• No attempt to record medications taken at home prior to ED arrival/visit
• Patients and providers not blinded to administration of haloperidol
• Unknown what effect intravenous haloperidol or differing the dose of haloperidol would have on clinical efficacy

Discussion:

• Although the ED length of stay was not statistically significant, many believe a 14 hour reduction in length of stay would be clinically significant.

Author Conclusion: “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.”

Clinical Take Home Point: In this small, retrospective study, 5mg IM Haldol decreased rates of admission and amounts of opioids administered in patients with diabetic gastroparesis. Haldol could be a potential addition to the armamentarium of treatment in this difficult to treat disease process.

References:

1. Ramirez R et al. Haloperidol Undermining Gastroparesis Symptoms (HUGS) in the Emergency Department. AJEM 2017 [epub ahead of print]

For More on This Topic Checkout:

Ken Milne at The SGEM: SGEM #196 – Gastroparesis – I Fell Like Throwing Up

Post Peer Reviewed By: Matt Astin (Twitter: @mastinmd)

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