RSS Feeds
Torsade de Pointes Associated with the Use of Intravenous Haloperidol
- Jeffrey L. Wilt, MD;
- Ann Mary Minnema, MD;
- Robert F. Johnson, MD; and
- Andrew M. Rosenblum, MD
- From St. Mary's Health Services and Blodgett Memorial Medical Center, Grand Rapids, Michigan. Requests for Reprints: Jeffrey L. Wilt, MD, Section of Pulmonary and Critical Care Medicine, P.O. Box 9166, West Virginia University, Morgantown, WV 26506-9166. Acknowledgments: The authors thank David Vidro for help with figure production and Dr. Angela Tiberio for help with manuscript preparation.
Intensive-care-unit delirium requires rapid treatment to prevent morbidity [1]. Intravenous haloperidol (Haldol, McNeil Pharmaceuticals, Spring House, Pennsylvania) has been used frequently in recent years to combat intensive-care-unit delirium. Its advantages include minimal cardiac effects, even at doses greater than 100 mg/d [2]. We present four cases of haloperidol-associated torsade de pointes [3] developing in intubated patients with intensive-care-unit delirium.
Case Reports
Patient 1
A 39-year-old woman with bacterial meningitis developed acute congestive heart failure on hospital day 20 and required reintubation and intravenous haloperidol (5-mg increments) and lorazepam (Ativan, Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania) administration for sedation. Progressive Q-T interval widening was noted (Figure 1). On day 23, torsade de pointes developed Figure 1, and the haloperidol was discontinued (dosage, 580 mg over a 4-day period). Atropine was administered, the QTc interval normalized Figure 1, and no further dysrhythmia was noted. Concurrent medications included furosemide, penicillin G, methylprednisolone, digoxin, terazosin, and nitroglycerin.
Patient 2
A 19-year-old woman with status asthmaticus received sedation with intravenous haloperidol (5- or 10-mg increments) and lorazepam. She experienced progressive Q-T interval widening Figure 2 and developed monomorphic ventricular tachycardia that was unresponsive to defibrillation. She responded transiently to intravenous …
