Delirium
Neuropsychiatric Conditions
F05.0-1/F05.8-9/R45.1/ + (Z51.5)
See: Delirium with acute confusion and aggression in adults.
DESCRIPTION
Delirium (confusion) is common in the terminal stages of advanced disease, but is rarely seen in children. Supportive measures such as frequent re-orientation may be useful.
GENERAL MEASURES
Assess for underlying causes e.g. infection, electrolyte imbalance.
Remove factors that can agitate patient (full bladders, thirst, pain, constipation).
Reduce polypharmacy.
Monitor for sensory deficits e.g. hearing impairment.
MEDICINE TREATMENT
|
CAUTION Rapid tranquillisation may cause cardiovascular collapse, respiratory depression, neuroleptic malignant syndrome and acute dystonic reactions. The elderly, children, intellectually disabled and those with comorbid medical conditions and substance users are at highest risk. An emergency trolley, airway, bag, oxygen and intravenous line must be available. |
Adults:
For hyperactive delirium and severe agitation:
- Benzodiazepine, e.g.:
- Diazepam, IV, 2.5–5 mg as a single dose
- If no response, give a second dose.
- Do not administer at a rate over 5 mg/minute.
LoE:IIIb13
OR
- Midazolam, IM, 1–5 mg immediately.
- Repeat after 30–60 minutes if needed.
- Lower doses are indicated for patients with liver failure.
Switch to oral benzodiazepine if possible.
LoE:IIIb14
|
CAUTION - BENZODIAZEPINES - Associated with cognitive impairment – reversible with short-term use and irreversible with long-term use. - Elderly are at risk of over-sedation, falls and hip fractures. - Dependence may occur after only a few weeks of treatment. - Prescribe for as short a period of time as possible. - Warn patient not to drive or operate machinery when used short-term. - Avoid use in people at high risk of addiction – personality disorders and those with previous or other substance misuse. LoE:IIIb15 |
REFERRAL
- All children
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 22: Medicines Used in Palliative Care_22.2 Neuropsychiatric Conditions_22.2.2 Delirium