The treatment of delirium is the identification and treatment of the underlying cause while maintaining safety and comfort.
Who Gets Admitted?
Not all patients with delirium need to be admitted, but safe discharge requires:
- The delirium to be identified
- AND a single, clear, and reversible etiology to be identified
- AND the presence and understanding of family or friends who can observe the patient until the delirium resolves.
Examples of Safe Discharge:
Treating the Symptoms of Delirium
Patients, families and ED staff are most bothered by the symptoms of delirium – usually the agitation. These agitative symptoms can be treated in two ways:
- 0.5mg-1.0mg PO/IM/SC/IV q30minutes prn – reassess after 3 doses. Try PO route first.
Respiridone, Olanzapine may also be useful, but are more difficult to dose, have a longer half-life, and are not always available in the ED.
- avoid/remove restraints including catheters and non-essential monitor leads
- promote mobility
- allow/encourage food and drink
- address bowel and bladder function
- increase sensory stimulation (hearing aid, eye glasses)
- enhance orientation and familiar faces (family)
- minimize medication changes (i.e. make sure they’re getting what they get at home)
- manage pain.
Haloperidol — the Wonder Drug!
- Commonly available
- High potency
- Limited anti-cholinergic effects
- Available in both oral and parenteral forms
- However it is anti-dopaminergic so it may cause problems in Parkinsonian patients because of increased extra pyramidal symptom.