March 30, 2017

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)

Cite this article as: Salim Rezaie, "Diabetic Gastroparesis Needs HUGS", REBEL EM blog, March 30, 2017. Available at: https://rebelem.com/diabetic-gastroparesis-needs-hugs/.
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Salim Rezaie

Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)
Creator & Founder of R.E.B.E.L. EM
8 Comments
  • Tony Seupaul
    Posted at 16:10h, 01 April Reply

    This is a nice find. Very little downside to the use of haldol considering the usual regimen of meds +/- hospitalization that is typically required.

  • Paul Richard
    Posted at 05:11h, 18 April Reply

    Very detailed information is provided in the post about the treatment of Gastroparesis. The dietary guidelines will really help those who experiencing the problem. Thanks!

    • Salim Rezaie
      Posted at 10:53h, 18 April Reply

      TY for reading and the comment Paul.

      Salim

  • Episode 73 – Gastroparesis & Biliary Pathology | FOAMcast
    Posted at 20:10h, 31 August Reply

    […] Salim Rezzaie of RebelEM wrote a blog post on HUGS – Haloperidol for Gastroparesis.  This study had significant methodologic […]

  • Steve Mac
    Posted at 13:02h, 19 October Reply

    I’ve been using this for years with chronic gastropathy patients, and in addition to benefits of findings above, I strongly believe it helps reduce addiction to powerful opioic medications, particularly in the naive patients we see like the cannabis hyperemesis syndromes.

  • SGEM#196: Gastroparesis – I Feel Like Throwing Up | The Skeptics Guide to Emergency Medicine
    Posted at 10:41h, 27 November Reply

    […] A retrospective study was published earlier this year on haloperidol for the treatment of gastroparesis secondary to diabetes mellitus. It was called HUGS and showed lower hospital admissions and opioid use in patients receiving 5mg of haloperidol (Ramirez et al AJEM). You can find a good review on this paper on REBEL EM. […]

  • Susan George
    Posted at 01:51h, 02 December Reply

    Thanks for the nice title and information on gastroparesis

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