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Delirium Dementia Case Study

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Delirium is a clinical emergency characterized by changes in consciousness, hallucinations, changes in sleep- wake cycle and language changes. Delirium is a frequent event in patients with advanced cancer. Factors predisposing to delirium in advanced cancer include drugs, infection, brain metastasis and underlying dementia.1 Delirium differs from dementia in that dementia does not have acute alterations in consciousness.2 Delirium is classified according to patient’s agitation. The agitated patient has hyperactive delirium and the withdrawn somnolent patient has hypoactive delirium.3 Patients usually have mixed features. Prevalence rates for delirium range from 30- 50% for hospitalized patients and is nearly universal in the hours or days …show more content…

Investigations should be tailored to the patient’s specific goals of care. This is important as 50% of cases of delirium are reversible. Clinicians look for infection, dehydration drug and metabolic abnormalities as potentially reversible causes of delirium. Cancer patients should be evaluated for CNS metastasis. Fecal impaction and urinary tract infection are often overlooked as causes of delirium. Common drugs linked to delirium are opioids, anticholinergics, benzodiazepines steroids and some chemotherapy agents. Asking about alcohol intake is important as alcohol withdrawal can precipitate delirium and responds to benzodiazepines. Nonpharmacologic approaches to delirium include, keeping lights on, having calendars and pictures at the bedside, frequent redirection, and allowing participation in care. …show more content…

Guidelines14 suggest that in elderly patients, and in patients with mild to moderately agitation , haloperidol can be started at low doses—i.e., 0•5 mg (orally) twice to three times a day—and then be titrated to obtain an effect. Severe cases and younger patients need more haloperidol. In the severely agitated patient rapid dosing is needed. In this situation parenteral doses are recommended and haloperidol doses such as 1–2 mg in young patients and 0.25–0.5 mg in elderly patients (≥60 years), repeated after 1–2 h are given until agitation resolves. Protocols for rapid titration are available.15 Haloperidol is the least sedating of the antipsychotics and can be given intravenously and by mouth. 16The atypical antipsychotics are useful as they have less propensity for EPS and less potential for effects on cardiac conduction.17 The atypical antipsychotics are not able to be given by the parenteral route. Commonly used atypical antipsychotics include olanzapine, quetiapine and risperidone. The atypical antipsychotics are also ideal for the patient with underlying Parkinson’s disease. Benzodiazepines are not indicated for management of delirium and are best used in setting of delirium associated with alcohol

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