Haldol in burn

Q: Why should Haloperidol be used with caution in burn patients?

Answer: Neuropsychiatric complications are commonly seen in major burn patients. Haloperidol is frequently used to treat severe psychopathic behavior. In burn patients, there could be an increased tendency for severe muscle rigidity, an extrapyramidal side effect of the agent. Haloperidol causes a relative imbalance of dopaminergic and cholinergic neuronal activity in the basal ganglia, with a relative increase in cholinergic activity responsible for EPS. The burn patient may be more prone to extrapyramidal symptoms because of the increased sensitivity of skeletal muscle neuromuscular junctions to acetylcholine after thermal injury.

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References:

1. Datta PK, Roy Chowdhury S, Aravindan A, Saha S, Rapaka S. Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice. Cureus. 2022 Nov 15;14(11):e31550. doi: 10.7759/cureus.31550. PMID: 36540501; PMCID: PMC9754771.

2. Huang V, Figge H, Demling R. Haloperidol complications in burn patients. J Burn Care Rehabil. 1987 Jul-Aug;8(4):269-73. doi: 10.1097/00004630-198707000-00006. PMID: 3654715.

3. Chang CM, Wu KY, Chiu YW, Wu HT, Tsai YT, Chau YL, Tsai HJ. Psychotropic drugs and risk of burn injury in individuals with mental illness: a 10-year population-based case-control study. Pharmacoepidemiol Drug Saf. 2016 Aug;25(8):918-27. doi: 10.1002/pds.3995. Epub 2016 Mar 28. PMID: 27476980.