By Conrad Fischer
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A room with low lighting is favorable in the management of delirium, but a dark room is contraindicated. Haloperidol, which is a high-potency, antipsychotic medication, can be used to control the agitation. The side effects of haloperidol include extrapyramidal symptoms, a reduced seizure threshold, and prolongation of the QT interval, which can lead to torsades de pointes. Prolongation of the QT interval of greater than 450 milliseconds warrants telemetry monitoring. Chlorpromazine is another antipsychotic medication that can be used for the treatment of the symptoms of delirium.
Hypoactive reflexes and cardiac arrhythmias can also be seen. The diagnosis of HPP is confirmed by the history of repeated episodes of weakness with hypokalemia. In this case, the patient came into the emergency department with mostly proximal muscle paralysis and hypokalemia confirming the diagnosis. A muscle biopsy may be done that will show single or multiple centrally placed vacuoles. When the patient does not present with dramatic paralysis, a provocative test using glucose and insulin may be used, but this needs to be done only in a carefully monitored setting.
Assessing the concentration of medications is not routinely available as a commercial test. Continuation of the same medications, as well as follow-up of the HIV viral load in 3 months, would be too dangerous for the patient. He does not have a well-controlled virus. Changing his regimen to two new nucleoside reverse-transcriptase inhibitors and a new protease inhibitor is not suggested without knowledge of the viral genotype. There is a possibility that the virus would be resistant to new medications as well.