F02.0-4/F02.8/F03/F05.0-1/F05.8-9 + (Z51.5)
DESCRIPTION
Delirium (confusion) is very common in the terminal stages of advanced disease and is associated with a short prognosis. When treatment of the underlying cause(s) of delirium is not possible or unsuccessful, pharmacological management is necessary. Causal treatment may not be indicated in patients with limited prognosis and pharmacological symptomatic therapy has to be initiated without delay.
GENERAL MEASURES
Assess for underlying causes e.g. infection or electrolyte imbalance.
Remove factors that can agitate the patient (e.g. full bladder, thirst, pain, constipation, medicines such as opioids, steroids, benzodiazepines, withdrawal of medicines, dehydration, liver or renal impairment and cerebral tumour).
Reduce polypharmacy.
Where appropriate, ensure adequate fluid and nutritional intake (not indicated in the pre-terminal stage).
Mobilise early when appropriate.
Monitor for sensory deficits and manage accordingly e.g. using hearing aids.
Keep the family involved and informed. Provide tools of care such as how to orientate and reassure the patient.
MEDICINE TREATMENT
- Haloperidol, SC/IV, 0.5 mg 8 hourly.
OR
- Haloperidol, oral, 0.75–5 mg 12 hourly.
In the elderly or where there is no response or resistance to haloperidol:
ADD
- Lorazepam, oral, 0.5–1 mg 2–4 hourly as required.
- Tablets may be crushed and administered sublingually.
OR
Patients unable to swallow:
- Midazolam, SC/IV, 0.5–5 mg immediately
- Titrate up slowly.
- Lower doses are indicated for patients with liver dysfunction.