Acute Laryngeal Dystonia Following Haloperidol Administration: Early Recognition Prevents Intubation

Acute laryngeal dystonia (ALD) is a rare but potentially fatal extrapyramidal adverse effect of high-dose antipsychotic medications like haloperidol. It presents with sudden contraction of laryngeal muscles that causes narrowing of the airway, which rapidly progresses to respiratory failure if not promptly recognized. We report a 45-year-old male patient with schizophrenia who developed respiratory distress and inspiratory stridor within 15 minutes of receiving haloperidol for postoperative agitation following emergent abdominal surgery. Initial management with epinephrine failed to improve symptoms. Given the temporal association with haloperidol administration, an acute dystonic reaction was suspected, and the patient was promptly treated with intravenous diphenhydramine and benztropine, resulting in immediate improvement of respiratory distress. Anticholinergic therapy was continued for one week with no recurrence of symptoms. This case highlights the importance of early recognition of ALD in postoperative and critical care settings, as timely administration of anticholinergic agents can be life-saving and may prevent unnecessary endotracheal intubation. It is recommended to continue anticholinergic agents for a prolonged period of time, even after haloperidol discontinuation, to prevent the recurrence of symptoms that have been reported in many cases in the past.