II. Epidemiology
- Delirium Incidence in terminally ill patients: 25 to 85%
- Sedation required in 25% of patients
- Reversible in 50% of patients
III. Causes
- Hypoxia (e.g. Atelectasis)
- Dehydration (Blood Urea Nitrogen >18 mg/dl)
- Hepatic Encephalopathy
- Brain Metastases
- Uncontrolled pain
- Constipation
- Electrolyte disturbance
- Infection or fever
- Medications
IV. Risk Factors
- Impaired Vision (Snellen Chart <20/70)
- Severe illness
- Cognitive Impairment (Mini-Mental State Exam <24)
- Major Depression (Mood Disorders in Cancer)
- Emotional stress
- Unfamiliar environment
- Immobilization
V. Management
- See Delirium
- Consider potentially reversible causes above
- Consider gentle rehydration if Dehydration suspected
- Reduce risk factors above
- Family member or sitter presence may calm patient
- Avoid precipitating events
- Avoid Physical Restraints
- Avoid Malnutrition
- Avoid adding more than three medications per day
- Avoid Bladder Catheterization
- Avoid frequent changes in environment or staff
- Consider medications for Delirium with Agitation refractory to other measures
- Haloperidol 0.5 to 5 mg PO, IV, SC, IM q2 to 12 hours
- Agents with adverse effects but long response delay
- Consider short-acting sedation if refractory to above (risk of paradoxical Agitation)
- Other measures