A thirty year old female with a history of poorly controlled type 1 diabetes and gastroparesis presents for 1 day of severe abdominal pain, nausea, and vomiting. The patient states that she cannot keep anything down including fluids and has been vomiting all day. Her last bowel movement was today. She denies missing any insulin doses. Vital signs are: Temp 98.2F, HR 98, BP 130/80, RR 18, SpO2 98% RA. POC glucose is 182. She appears to be in obvious discomfort and is pacing circles in the room as well as intermittently dry heaving into an emesis bag. Her abdomen is soft but she notes tenderness to palpation diffusely, worst over the epigastric area. Which of the following medications has been shown to decrease need for admission and additional analgesic administration for patients with this condition?
A: erythromycin
B: haloperidol
C: hydromorphone
D: metoclopramide
E: odansetron
Answer: haloperidol
Gastroparesis is a chronic disorder characterized by delayed gastric emptying without a mechanical obstruction. It is commonly associated with diabetes although a considerable percentage of cases are idiopathic. In a 2017 observational study, haloperidol was shown to have a significant decrease in the rate of admission and analgesia administration in patients with gastroparesis. Odansetron, metoclopramide, and erythromycin are anti-emetics and prokinetic agents for gastroparesis but have no proven benefit in admission rates and pain control. Hydromorphone is a potent analgesic but has no anti-emetic properties and has a common side effect of nausea.
| Management of Gastroparesis |
| IV fluids, electrolyte repletion Anti-emetics: haloperidol, odansetron, metoclopramide Prokinetics: metoclopramide, erythromycin Glycemic control Identifying triggers |
References:
Ramirez, R., Stalcup, P., Croft, B., & Darracq, M. A. (2017). Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department. The American journal of emergency medicine, 35(8), 1118–1120. https://doi.org/10.1016/j.ajem.2017.03.015
