Haloperidol-induced torsades de pointes.
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概要
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A 35-year-old male with schizophrenia was admitted for heat burn resulting from a suicide attempt. Haloperidol was injected for delirium from the fourth day. On the sixth day, after a 20mg-injection of haloperidol, ECG revealed multifocal ventricular tachycardia, that is torsades de pointes (TdP), which was induced after R-on-T phenomenon. The corrected QT interval was slightly prolonged to 0.52, but the shape of the T wave was normal. The serum potassium concentration was 3.7mEq/l, but the serum magnesium concentration was not measured. The TdP was exacerbated in the sinus tachycardia phase and diminished as heart rate decreased i.e. the TdP was adrenergic dependent. The TdP disappeared with discontinuation of the haloperidol and injection of magnesium sulfate. The serum haloperidol concentration increased to the toxic range, 92ng/ml, 8 hours after its discontinuation. To our knowledge, this is the first report of TdP induced by intravenous injection of haloperidol. The adrenergic-dependent TdP occurred in the setting of mild hypokalemia and probable hypomagnesemia due to serious burn injury, and was successfully treated with an injection of magnesium sulfate. Based on these observations, clinicians should monitor ECG when using haloperidol especially in patients with ionic-metabolic imbalances.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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