Accidental haloperidol poisoning in children
A 6 year old female child was brought with complaints of altered sensorium, persistent vomiting since the last 6 h. The patient responded to deep painful stimuli, and was intermittently agitated, febrile with a pulse of 104/min, respiratory rate 18/min, BP 80/40 mm Hg with excessive sweating. On central nervous system (CNS) examination, the pupils were normal, tone was dystonic with intermittent opisthotonus posturing, exaggerated reflexes and ill-sustained clonus was present. Rest of the systemic examination was normal. The working diagnosis and management was of an unknown poisoning, and on deep probing, the history of alleged ingestion of haloperidol was obtained. The child and her brother had consumed an indeterminate amount of 5 mg haloperidol tablets while playing in the backyard about 7 h prior to admission. These tablets were apparently thrown in the open by a neighbor who was under treatment for schizophrenia. The child was given gastric lavage, started on intravenous fluids, bladder catheterization was done. Blood investigations and electrocardiogram (ECG) were normal. Promethazine hydrochloride 0.1 mg/kg and trihexyphenidyl 2 mg/dose thrice-daily was initiated and later increased to 3 mg/dose in view of persistent dystonia. Patient responded dramatically and regained consciousness after 12 h with complete resolution of dystonia within 72 h.